Intraoperative Carotid Peak Systolic Velocity Variability in Liver Transplant Patients

Aim: The aim of this study was to evaluate carotid peak systolic velocity variability using intraoperative ultrasound and to determine whether this method is useful in the assessment of hemodynamic status and intravascular volume in liver transplantation. Previously, a similar study was performed in liver transplant intensive care unit, but no study was performed to evaluate intraperative fluid status with carotid ultrasonography.

Material and Method: Our prospective, single-center study was conducted at the Inonu University Faculty of Medicine, Turgut Ozal Medical Center Liver Transplant Institute, between Semtember 18, 2023, and April 29, 2024. After excluding patients with fulminant hepatic failure requiring emergency transplantation and those outside the age range of 18-65 years, 42 patients out of a total of 89 liver transplant recipients were included. Masimo non-invasive probe was inserted for pleth variable index (PVI), perfusion index (PI), oxygen reserve index (ORI), SpHb measurement and input values were recorded. After invasive arterial monitoring, which is routinely performed in transplant patients, cardiac output, stroke volume, stroke volume variation, dPmax were monitored by pulse contour analysis method and values were recorded. At the beginning of the dissection phase, carotid ultrasound was performed and values were recorded (T0). After the portal vein and v. cava inf. were clamped (anhepatic period), carotid ultrasound was performed and values were recorded (T1). Hemodynamic, respiratory, routine laboratory data and hourly urine output were recorded throughout the operation.

Inclusion criteria

• Adult patients scheduled for elective liver transplantation

Exclusion criteria

• fulminant hepatic failure requiring emergency transplantation, patients with carotid artery disease