Flushing with autologous blood improves intraoperative hemodynamic stability and early graft function in clinical hepatic transplantation

Hemodynamic instability and hyperkalemia are common after reperfusion and may cause ischemic damage on the hepatic allograft. Two techniques for flushing hepatic grafts before reperfusion were studied to evaluate their effects on intraoperative hemodynamic and metabolic status and on early graft function in 83 consecutive adult hepatic transplantations. In the first 41 patients (group 1), the hepatic grafts were rinsed with 500 milliliters of lactated Ringer's solution (LR). In the subsequent 42 patients (group 2), in addition to LR rinse, the first 500 milliliters of portal blood to flush and reperfuse the liver were drained through the cannula inserted into the donor vena cava before unclamping the vena cava. After reperfusion, the mean arterial pressure decreased 30±4 percent in group 1 versus 17±2 percent in group 2 (p<0.02), and serum K⁺ increased by 1.9±0.2 in group 1 versus 0.8±2 milliequivalents per liter in group 2 (p<0.01). Hyperkalemic cardiac arrest was only seen in two patients in group 1. The K⁺ concentration in the first 100 milliliters of discarded blood was found to be 40±2 milliequivalents per liter. The 500 milliliters of discarded blood contained 8.3±0.4 milliequivalents, which was correlated with graft liver weight (p<0.001). Early graft function, as measured by serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, total bilirubin and prothrombin time on postoperative day No. 2, was significantly better in group 2 than in group 1 (p<0.05). The six-month graft and patient survival rates in group 1 were 66 and 75 percent, versus 90 and 95 percent in group 2 (p<0.01 and p<0.02, respectively). Further flushing with 500 milliliters of autologous portal blood resulted in smaller intraoperative shifts in serum K⁺, greater hemodynamic stability, better graft function and improved graft and patient survival.