Hepatic Vein Flow Index During Orthotopic Liver Transplantation as a Predictive Factor for Postoperative Early Allograft Dysfunction

OBJECTIVES: The authors devised a hepatic vein flow index (HVFi), using intraoperative transesophageal echocardiography and graft weight, and investigated its predictive value for postoperative graft function in orthotopic liver transplant. DESIGN: Prospective clinical trial. SETTING,: Single-center tertiary academic hospital. PARTICIPANTS: Ninety-seven patients who had orthotopic liver transplant with the piggy-back technique between February 2018 and December 2019. MEASUREMENTS AND MAIN RESULTS: HVFi was defined with HV flow/graft weight. Patients who developed early graft dysfunction (EAD) had low HVFi in systole (HVFi sys, 1.23 v 2.19 L/min/kg, p \u3c 0.01), low HVFi in diastole (HVFi dia, 0.87 v 1.54 L/min/kg, p \u3c 0.01), low hepatic vein flow (HVF) in systole (HVF sys, 2.04 v 3.95 L/min, p \u3c 0.01), and low HVF in diastole (HVF dia, 1.44 v 2.63 L/min, p \u3c 0.01). More cardiac death, more vasopressors at the time of measurement, more acute rejection, longer time to normalize total bilirubin (TIME t-bil), longer surgery time, longer neohepatic time, and more packed red blood cell transfusion were observed in the EAD patients. All HVF parameters were negatively correlated with TIME t-bil (HVFi sys R = -0.406, p \u3c 0.01; HFVi dia R = -0.442, p \u3c 0.01; HVF sys R = -0.44, p \u3c 0.01; HVF dia R = -0.467, p \u3c 0.01). The receiver operating characteristic curve analysis determined the best cut-off levels of HVFi to predict occurrence of EAD (HVFi sys \u3c1.608, HVFi dia \u3c0.784 L/min/kg), acute rejection (HVFi sys \u3c1.388, HVFi dia \u3c1.077 L/min/kg), and prolonged high total bilirubin (HVFi sys \u3c1.471, HVFi dia \u3c1.087 L/min/kg). CONCLUSIONS: The authors\u27 devised HVFi has the potential to predict the postoperative graft function