Right ventricular function during orthotopic liver transplantation

Right ventricular (RV) function was assessed in 20 patients undergoing orthotopic liver transplantation to determine its role in the hemodynamic instability frequently seen during this procedure. A modified pulmonary artery catheter equipped with a fast response thermistor was used to determine RV ejection fraction (EF(rv)), allowing for calculation of RV end- diastolic volume index (EDVI(rv), as the ratio of stroke index [SI] to EF(rv)) and RV end-systolic volume index (ESVI(rv), as the difference between EDVI(rv) and SI). The above hemodynamic measures were taken during dissection for hepatectomy (stage I), during the anhepatic stage (stage II), and after reperfusion of the grafted liver, the neohepatic stage (stage III). No patient had pulmonary hypertension during the study interval. No correlation was observed between right atrial pressure (P(ra)) and EDVI(rv), indicating that P(ra) is a less reliable clinical indicator of RV preload. RV function appeared to be well preserved throughout the procedure, as indicated by a relatively constant and supranormal EF(rv), although a small and probably clinically unimportant decrease in EF(rv) was observed during the anhepatic stage (0.52, 0.50, and 0.55 during stages I, II, and III, respectively). There was a strong correlation between SI and EDVI(rv) for pooled data over a wide range of EDVI(rv) (60-185 mL · m^-2). Although unstable central blood temperature precluded the determination of EF(rv) within the first 5 min after reperfusion, RV function was unaltered otherwise during uncomplicated orthotopic liver transplantation using venovenous bypass, indicating that orthotopic liver transplantation per se is not associated with significant RV dysfunction.