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• W2092405397 abstract "Liver transplant (LT) is a major surgical undertaking involving major fluid shifts, hemodynamic instability and metabolic derangements in a patient with preexisting liver failure and multisystemic derangements. Monitoring and organ support initiated in the preoperative phase is continued intraoperatively and into the postoperative phase to ensure an optimal outcome. As cardiovascular events are the leading cause of non-graft related death among LT recipients, major emphasis is placed on cardiovascular monitoring. The other essential monitoring are the continuous assessment of coagulapathy, extent of metabolic derangements, dyselectrolytemis and intracranial pressure monitoring in patients with fulminant hepatic failure. The type and extent of monitoring differs with need according to preexisting child status of the patient and the extent of systemic derangements. It also varies among transplant centers and is mainly determined by individual or institutional practices. Liver transplant (LT) is a major surgical undertaking involving major fluid shifts, hemodynamic instability and metabolic derangements in a patient with preexisting liver failure and multisystemic derangements. Monitoring and organ support initiated in the preoperative phase is continued intraoperatively and into the postoperative phase to ensure an optimal outcome. As cardiovascular events are the leading cause of non-graft related death among LT recipients, major emphasis is placed on cardiovascular monitoring. The other essential monitoring are the continuous assessment of coagulapathy, extent of metabolic derangements, dyselectrolytemis and intracranial pressure monitoring in patients with fulminant hepatic failure. The type and extent of monitoring differs with need according to preexisting child status of the patient and the extent of systemic derangements. It also varies among transplant centers and is mainly determined by individual or institutional practices. Liver transplant (LT) has become a feasible treatment option for acute as well as chronic end stage liver disease (ESLD), irresectable liver malignancies and also for several metabolic abnormalities. Liver diseases, necessitating LT can either be acute or chronic. Each disease entity presents unique features as well as important differences. While cirrhosis is a slow and insidious liver dysfunction, acute liver failure (ALF) presents with liver dysfunction, coagulopathy and hepatic encephalopathy occurring within days or weeks, often leading to a life-threatening multisystem illness and a rise in intracranial pressure (ICP). Severe hemodynamic, hematological and metabolic abnormalities are common. LT is a major surgical undertaking involving major hemodynamic shifts and metabolic derangements necessitating extensive monitoring and support of all organ systems. It is now becoming increasingly possible to offer transplant to sicker patients with multiple co-morbidities and organ dysfunction, as monitoring and organ support initiated in the preoperative phase is continued intraoperatively and into the postoperative phase to ensure an optimal outcome. Cardiorespiratory failure has been identified as the commonest cause for ICU readmission after LT and cardiovascular events are the leading cause of non-graft related death among LT recipients.1Levy M.F. Greene L. Ramsay M.A. et al.Readmission to the intensive care unit after liver transplantation.Crit Care Med. 2001; 29: 18-24Crossref PubMed Scopus (66) Google Scholar Major emphasis is therefore placed on cardiovascular monitoring during perioperative care of these patients. Patients with cirrhosis and portal hypertension have a hyperdynamic circulatory state, with high cardiac output (CO) and a low systemic vascular resistance (SVR).2Henriksen J.H. Bendtsen F. Sorensen T.I.A. et al.Reduced central blood volume in cirrhosis.Gastroenterology. 1989; 97: 1506-1513Abstract PubMed Google Scholar There is systemic vasodilatation and marked increase in splanchnic capacitance. As a result, the central blood volume is significantly reduced. Due to this relative hypovolemia and major fluid shifts which occur during surgery, there is a need for a reliable hemodynamic monitoring tool for fluid management, so as to maintain the delicate balance between optimizing preload and avoiding pulmonary edema.3Liu H. Gaskari S.A. Lee S.S. Cardiac and vascular changes in cirrhosis: pathogenic mechanisms.World J Gastroenterol. 2006; 12: 837-842PubMed Google Scholar Standard hemodynamic monitoring used routinely during adult LT includes continuous 5 lead ECG, invasive arterial pressure and cardiac output (CO) monitoring. Often both the radial arteries or a radial and a femoral artery are cannulated due to the need for frequent blood sampling and to enable continuous invasive blood pressure monitoring during the long surgery. Femoral arterial catheter is preferred over radial artery catheter by many, since central aortic pressure monitoring is considered more accurate especially at times of hemodynamic instability. Besides blood pressure monitoring using the radial artery is known to get affected by rib cage retraction causing subclavian artery compression.4Dulitz M.G. De Wolf A.M. Wong H. et al.Compression of brachial plexus during right lobe liver donation as a cause of brachial plexus injury: a case report.Liver Transplant. 2005; 11: 233-235Crossref PubMed Scopus (9) Google Scholar Changes in arterial and venous tone, intravascular volume, ventricular performance, peripheral vascular reactivity, core body temperature and changes in blood rheology make moment-to-moment assessment of cardiovascular status difficult. Clinical parameters like heart rate, blood pressure, blood loss and urine output are insufficient to direct fluid therapy for a recipient of LT. More detailed and accurate measurements are therefore needed for assessing cardiac preload, directing volume replacement and optimizing CO.5Moller S. Henriksen J.H. Cardiovascular complications in cirrhosis.Gut. 2008; 57: 268-278Crossref PubMed Scopus (286) Google Scholar Traditionally, pulmonary artery catheter (PAC) has been used for invasive hemodynamic monitoring during LT. Cardiac filling pressures, namely central venous pressure (CVP) and pulmonary arterial occlusion pressure (PAOP) measured using the PAC serve as a guide to right and left heart preload respectively. Till recently these cardiac filling pressures were widely used to guide fluid therapy, but recent studies have shown that these pressure-derived parameters, which are indirect indicators of ventricular filling volumes,6De Wolf A. Hemodynamic monitoring during orthotopic liver transplantation.Transpl Proc. 1993; 25: 1863PubMed Google Scholar, 7De Wolf A.M. Begliomini B. Gasior T.A. et al.Right ventricular function during orthotopic liver transplantation.Anesth Analg. 1993; 76: 562Crossref PubMed Scopus (78) Google Scholar have little positive predictive value in improving hemodynamics or tissue perfusion.8Kumar A. Anel R. Bunnell E. et al.Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects.Crit Care Med. 2004; 32: 691Crossref PubMed Scopus (628) Google Scholar The PAC was initially used only to measure intracardiac pressures, but CO measurement using the thermodilution principle (TDCO) has now become an integral function of the PAC. Advances in technology have allowed for the development of continuous CO (CCO) monitoring by incorporating a heating coil within the PAC (CCOmbo/Vigilance, Edwards Lifesciences LLC, Irvine, CA; Opti Q CCO/Q-vue, Abbott Critical Care Systems, Mountain View, CA). This obviates the need for bolus injections and provides average CO over time compared with intermittent bolus techniques9Greim C.A. Roewer N. Thiel H. et al.Continuous cardiac output monitoring during adult liver transplantation: thermal filament technique versus bolus thermodilution.Anesth Analg. 1997; 85: 483-488PubMed Google Scholar and still allows for monitoring of CVP, mean pulmonary artery pressure (mPAP) and PAOP. Advances in computation techniques have resulted in development of algorithms to calculate the global end-diastolic volume and the right ventricular end-diastolic (RVEDV) and end-systolic volumes, thereby facilitating better estimation of intravascular blood volume.10Della Rocca G. Costa M.G. Feltracco P. et al.Continuous right ventricular end diastolic volume and right ventricular ejection fraction during liver transplantation: a multi center study.Liver Transpl. 2008; 14: 327-332Crossref PubMed Scopus (40) Google Scholar RVEDV is a valuable index of cardiac preload and is a more sensitive indicator of intravascular volume when compared with CVP and PAOP.11Cheatham M.L. Nelson L.D. Chang M.C. Safesak K. Right ventricular end diastolic volume index as a predictor of preload status in patients on positive end expiratory pressure.Crit Care Med. 1998; 26: 1801-1806Crossref PubMed Scopus (116) Google Scholar, 12Costa M.G. Chiarandini P. Della Rocca G. Hemodynamics during liver transplantation.Transpl Proc. 2007; 39: 1871-1873Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar The PAC however, might be inaccurate if it is not positioned correctly and may not reflect changes in intravascular volume rapidly enough. With reported hazards of PAC insertion like ventricular arrhythmias,13Gwak M.S. Kim J.A. Kim G.S. et al.Incidence of severe ventricular arrhythmias during pulmonary artery catheterization in liver allograft recipients.Liver Transpl. 2007; 13: 1451-1454Crossref PubMed Scopus (37) Google Scholar and due to availability of less invasive monitoring tools, the use of PAC is declining. It is now increasingly reserved, for those cases where there is a suspicion of porto pulmonary hypertension,14Wiener R.S. Welch H.G. Trends in the use of the pulmonary artery catheter in the United States, 1993–2004.JAMA. 2007; 298: 423-429Crossref PubMed Scopus (258) Google Scholar as severe pulmonary hypertension (mPAP > 45) is associated with high perioperative mortality and, if not successfully treated, is a contraindication to LT.15Murray K.F. Carithers R.L. AASLD practice guidelines: evaluation of the patient for liver transplantation.Hepatology. 2005; 41: 1407-1432Crossref PubMed Scopus (599) Google Scholar Standard hemodynamic monitoring, such as arterial pressure monitoring, can also be extended for the assessment of CO, preload and afterload. A number of such devices are commercially available which provide a continuous estimate of CO through analysis of the shape of the arterial pulse wave from a peripherally placed arterial catheter. This technique helps measure stroke volume (SV) and CO on a beat-to-beat basis and helps assess requirement of therapies such as fluid challenge and/or inotropes.16Della Rocca G. Brondani Anita Costa Maria Gabriella Intraoperative hemodynamic monitoring during organ transplantation: what is new?.Curr Opin Organ Transpl. 2009; 14: 291-296Crossref PubMed Scopus (42) Google Scholar The PiCCO system (Pulsion Medical System; Munich, Germany) is a commercially available, continuous CO monitor in which a femoral arterial catheter with a thermistor in its wall analyses the pulse contour. The working principle is based on an algorithm which analyzes the shape of the arterial pressure waveform and computes the pulsatile systolic area. Beat-to-beat calculations are averaged over 30-s cycles and are displayed as a numerical value providing information regarding the patient's preload (intrathoracic blood volume, ITBVI), afterload, myocardial contractility, CO and extra vascular lung water index (EVLWI).17Diaz S. Perez-Pena J. Sanz J. et al.Haemodynamic monitoring and liver function evaluation by pulsion cold system Z-201 (PCS) during orthotopic liver transplantation.Clin Transplan. 2003; 17: 47Crossref PubMed Scopus (11) Google Scholar ITBVI has shown a strong correlation with cardiac index (CI) as opposed to filling pressures in cirrhotics. It is regarded as a more reliable preload index during different phases of LT like during IVC clamping, graft reperfusion, bleeding and surgical manipulations.18DellaRocca G. Costa M.G. Coccia C. et al.Preload and haemodynamic assessment during liver transplantation: a comparison between the pulmonary artery catheter and transpulmonary indicator dilution techniques.Eur J Anaesthesiol. 2002; 19: 868-887Crossref PubMed Google Scholar The device is initially calibrated by TDCO, using cold saline injection via central venous catheter and subsequent detection by the thermistor in the femoral arterial catheter. Beat-to-beat calculations are averaged over 30-s cycles and displayed as a numerical value. CCO assessed by PICCO and by TDCO have been found to be comparable. The monitor however, needs to be recalibrated if the SVR changes markedly.19Della Rocca G. Costa M.G. Coccia C. et al.Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation.Can J Anesth. 2003; 50: 707-711Crossref PubMed Google Scholar, 20Della Rocca G. Costa M.G. Pompei L. et al.Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique.Br J Anaesth. 2002; 88: 350-356Crossref PubMed Scopus (200) Google Scholar Other popular commercial equipment that make use of pulse power analysis include the LiDCO plus (LiDCO Ltd; Cambridge, UK) and the FloTrac/Vigileo (Edwards Lifesciences LLC; Irvine, CA). Both devices use proprietary algorithms to derive CO and like PiCCO, both display pulse pressure variation and stroke volume variation, which are indicative of intravascular volume status.21Button D. Weibel L. Reuthebuch O. Genoni M. Zollinger A. Hofer C.K. Clinical evaluation of the FloTrac/Vigileo™ system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery.Br J Anaesth. 2007; 99: 329-336Crossref PubMed Scopus (147) Google Scholar Flo-Trac/Vigileo derives CO from the arterial waveform in conjunction with patient demographic data, without the need for an independent method of calibration. CO can be measured directly from a conventional arterial line attached to the sensor.22Biais M. Nouette-Gaulain K. Cottenceau V. et al.Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis.Anesth Analg. 2008; 106: 1480-1486Crossref PubMed Scopus (151) Google Scholar The LiDCO system needs to be calibrated using lithium dye. However, its advantage over other pulse contour derived methods is that it provides beat to beat changes in CO, while the Vigileo computes and displays SV values every 20 s. The values obtained from LiDCO and the FloTrac have been compared with PAC and found to be comparable.23Biancofiore G. Critchley L.A. Lee A. et al.Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery.Br J Anaesth. 2009; 102: 47-54Crossref PubMed Scopus (146) Google Scholar More recently transesophageal echocardiography (TEE) has become an essential perioperative diagnostic and monitoring tool.24De Wolf A.M. Aggarwal S. Monitoring preload during liver transplantation.Liver Transpl. 2008; 14: 268-269Crossref PubMed Scopus (23) Google Scholar It provides direct visualization of the function and volume status of the heart. It allows quick assessment of the changes in contractility and rapid diagnosis of ventricular dilatation and failure.25Burtenshaw A.J. Isaac J.L. The role of trans-oesophageal echocardiography for perioperative cardiovascular monitoring during orthotopic liver transplantation.Liver Transpl. 2006; 12: 1577-1583Crossref PubMed Scopus (77) Google Scholar During times of hemodynamic instability, TEE can help with immediate diagnosis of air or thromboembolus. CO can be derived by measurement of flow across a cardiac valve, left ventricular outflow tract, or the flow in the main pulmonary artery. The functional utility of TEE, is however limited as a hemodynamic tool during LDLT due to the fear of rupture of esophageal varices26Spier B.J. Larue S.J. Teelin T.C. et al.Review of complications in a series of patients with known gastro-esophageal varices undergoing transesophageal echocardiography.J Am Soc Echocardiogr. 2009; 22: 401-403Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar but is considered a reliable, hemodynamic monitoring tool where there is adequate operator experience. The preferred hemodynamic monitoring tool remains controversial because of lack of evidence indicating a difference in patient outcomes. Schumann27Schumann R. Intraoperative resource utilization in anesthesia for liver transplantation in the United States: a survey.Anesth Analg. 2003; 97: 21-28Crossref PubMed Scopus (83) Google Scholar surveyed 62 transplant centers in the United States and found that PACs were used in 30% of the centers and that TEE was used in 11.3%. In summary, the type of monitoring differs among transplant centers and is mainly determined by individual or institutional practice. In most centers, an arterial line is placed which is extended for CO monitoring using either Flotrac, LiDCO or PICCO, depending on individual preferences. The PAC is usually reserved for cases with suspected PHT and the TEE is used as per availability of expertise.28Krenn Claus-Georg De Wolf Andre M. Current approach to intraoperative monitoring in liver transplantation.Curr Opin Organ Transpl. 2008; 13: 285-290Crossref PubMed Scopus (41) Google Scholar Patients with liver disease are at increased risk of both thrombosis as well as hemorrhage,29Roberts L.N. Patel R.K. Roopen Haemostasis and thrombosis in liver disease.Br J Haematol. 2009; 148: 507-521Crossref PubMed Scopus (80) Google Scholar In patients with cirrhosis of liver and ESLD there occur abnormalities of both procoagulants (e.g. vWF, Factor VIII) and anticoagulants (e.g. protein C, antithrombin and tissue factor pathway inhibitor). LT has been associated with major blood loss30Yuasa T. Niwa N. Kimura S. et al.Intraoperative blood loss during liver transplantation: an analysis of 635 recipients at a single center.Transfusion. 2005; 45: 879Crossref PubMed Scopus (45) Google Scholar and need for transfusion of fairly large amounts of allogenic blood products. During LT, dissection in the presence of coagulopathy through the fragile and dilated collaterals leads to blood loss. Transfusion needs in these patients may vary between 2 and 13 packed RBC units during liver transplant to much more.31de Boer M.T. Molenaar I.Q. Hendriks H.G. et al.Minimizing blood loss in liver transplantation: progress through research and evolution of techniques.Dig Surg. 2005; 22: 265-275Crossref PubMed Scopus (126) Google Scholar, 32Ozier Y. Pessione F. Samain E. et al.French study group on blood transfusion in liver transplantation. Institutional variability in transfusion practice for liver transplantation.Anesth Analg. 2003; 97: 671Crossref PubMed Scopus (117) Google Scholar The inherent risks of use of blood products, along with scarcity of these resources, makes it important that these be used judiciously. Studies have linked intraoperative transfusions with significant decrease in 1-year survival33Butler P. Israel L. Nusbacher J. et al.Blood transfusion in liver transplantation.Transfusion. 1985; 25: 120Crossref PubMed Scopus (66) Google Scholar and the amount of blood product administered intraoperatively has been a significant predictor of ICU readmission. There has been a consistent decline in transfusion requirements over the years with refinement of surgical technique and revision in transfusion protocols. The evaluation and correction of coagulopathy is an essential part of the care of the liver recipient in the perioperative period. It includes diagnosing potential causes of hemorrhage, prediction of risk of bleeding and appropriate hemostatic therapy. Close observation of the surgical field, suctions, communication with the surgical team along with monitoring of coagulation indices in the operating room are a crucial part of management. Traditionally, coagulation has been monitored by Conventional coagulation tests (CCTs)34Cacciarelli T.V. Keeffe E.B. Moore D.H. et al.Effect of intraoperative blood transfusion on patient outcome in hepatic transplantation.Arch Surg. 1999; 134: 25Crossref PubMed Scopus (139) Google Scholar which include Prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count and plasma fibrinogen levels. Each of these measures a different aspect of the clotting process but even when put together, they may not provide a complete picture of the coagulation status and have a dubious role in guiding correction of coagulopathy prior to interventions. Anesthesiologists and intensivists managing liver transplant patients usually use a combination of coagulation studies to guide blood product replacement therapy during LT. These include CCTs with point of care (POC) devices which assesses the viscoelastic properties of whole blood, like thrombelastography (TEG), rotation thrombelastometry (ROTEM) and Sonoclot to overcome the limitations of CCTs.35Tripodi A. Mannucci P.M. Abnormalities of hemostasis in chronic liver disease: Reappraisal of their clinical significance and need for clinical and laboratory research.J Hepatol. 2007; 46: 727Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar These tests are repeated frequently during the surgery for correction of coagulopathy and reduce blood loss and transfusions. Thrombelastography (TEG) which measures the elastic property of fibrin from its formation to complete dissolution is widely used to monitor coagulation status. The importance of TEG during LT as a test of whole-blood coagulation, has been established in literature.36Massicotte L. Beaulieu D. Thibeault L. et al.Coagulation defects do not predict blood product requirements during liver transplantation.Transplantation. 2008; 85: 956-962Crossref PubMed Scopus (118) Google Scholar The test allows for in vivo interactions between platelets, red blood cells and other coagulation factors and clot development is displayed in real-time. Thrombelastometry (ROTEM) is another POC test. It is a variation of TEG and is based on measuring shear-elastic modules during clot formation in whole blood. TEG and ROTEM both measure and graphically display the changes in viscoelasticity of blood at all stages of the developing and resolving clot, i.e., the time until initial fibrin formation (reaction time [R], the kinetics of fibrin formation and clot development (angle [α]), the ultimate strength and stability of the fibrin clot (maximum amplitude [MA]), and clot lysis (fibrinolysis [CL]).37Salooja N. Perry D.J. Thromboelastography.Blood Coag Fibrin. 2001; 12: 327-337Crossref PubMed Scopus (284) Google Scholar(Figure 1) TEG and ROTEM are both fibrinolysis sensitive assays and allow for diagnosis of hyperfibrinolysis in bleeding patients38Ganter M.T. Hofer C.F. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices.Int Anesth Res Soc. 2008; 106: 1366-1375Google Scholar, 39Roullet S. Pillot J. Freyburger G. et al.Rotation thromboelastometry detects thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation.Br J Anaesth. 2010; 104: 422-428Crossref PubMed Scopus (141) Google Scholar and hence enable directed therapy. Literature shows that use of TEG and ROTEM in transfusion algorithms has led to reduced number of blood products transfused.40Coakley M. Reddy K. Mackie I. et al.Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests.J Cardiothorac Vasc Anesth. 2006; 20: 548-553Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar A survey undertaken in the United States revealed that TEG is being used only by a third of all programs involved with LT, while pediatric LT units rely more on CCT for coagulopathycorrection.27Schumann R. Intraoperative resource utilization in anesthesia for liver transplantation in the United States: a survey.Anesth Analg. 2003; 97: 21-28Crossref PubMed Scopus (83) Google Scholar ROTEM has been successfully used primarily in Europe. The reason for this disparity could be institutional availability and protocols. The Sonoclot measurements are based on detection of viscoelastic changes of whole blood or plasma. The Sonoclot Analyzer measures the kinetics of fibrin formation and clot development and provides information on the entire hemostasis process both as a qualitative graph, known as Sonoclot Signature and the quantitative values e.g. CR (the maximum slope of the Sonoclot Signature during initial fibrin polymerization and clot development), activated clotting time (ACT), clot rate (CR), and the platelet function (PF). The ACT is the time from activation of sample until the beginning of fibrin formation (Figure 2). However, the Sonoclot Analyzer has been criticized because its results were influenced by age, gender and platelet count41Horlocker T.T. Schroeder D.R. Effect of age, gender, and platelet counton Sonoclot coagulation analysis in patients undergoing orthopedic operations.Mayo Clin Proc. 1997; 72: 214-219Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar and it has shown poor reproducibility of measured variables, especially CR and PF.42Ekback G. Carlsson O. Schott U. Sonoclot coagulation analysis: a study of test variability.J Cardiothorac Vasc Anesth. 1999; 13: 393-397Abstract Full Text PDF PubMed Scopus (22) Google Scholar Others have found the Sonoclot Analyzer to be valuable in cardiac surgical procedures43MiyashitaT KuroM. Evaluation of platelet function by SonoClot analysis compared with other hemostatic variables in cardiac surgery.Anesth Analg. 1998; 87: 1228-1233PubMed Google Scholar, 44Saleem A. Blifeld C. Saleh S.A. et al.Viscoelastic measurement of clot formation: a new test of platelet function.Ann Clin Lab Sci. 1983; 13: 115-124PubMed Google Scholar and it has demonstrated a precision close to that of TEG. In more recent studies, test variability of ACT values determined by Sonoclot, were comparable in LT and has been found to be useful in the perioperative coagulation management.45Chapin J.W. Becker G.L. Hulbert B.J. et al.Comparison of thromboelastograph and Sonoclot coagulation analyzer for assessing coagulation status during orthotopic liver transplantation.Transpl Proc. 1989; 21: 3539PubMed Google Scholar The liver plays a central role in regulation of whole-body metabolism. Liver disease therefore can lead to major alterations in glucose, lipid and protein metabolism. Patients with cirrhosis have a peculiar endocrine profile with impaired glucose homeostasis. Serum insulin concentration in these patients is elevated by at least 2-folds while the glucagon concentration is increased by 5-folds. This occurs more due to augmented secretions than due to delayed clearance by the diseased liver.46Shangraw R.E. Jahoor F. Mechanism of dichloroacetate-induced hypolactatemia in humans with or without cirrhosis.Metabolism. 2004; 53: 1087-1094Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Despite normal gluconeogesis, there is hyperglycemia with hyperinsulinemia on account of impaired peripheral glucose oxidation due to insulin resistance.47Kruszynska Y.T. Home P.D. McIntyre N. Relationship between insulin sensitivity, insulin secretion and glucose tolerance in cirrhosis.Hepatology. 1991; 14: 103-111Crossref PubMed Scopus (135) Google Scholar Glucose metabolism further worsens during LT. Hyperglycemia during liver transplant surgery develops following steroid therapy during the reperfusion period, and is aggravated further due to glycogenolysis by the newly transplanted liver, decreased peripheral glucose utilization and insulin resistance.48Shmueli E. Walker M. Alberti G. et al.Normal splanchnic but impaired peripheral insulin-stimulated glucose uptake in cirrhosis.Hepatology. 1993; 18: 86-95Crossref PubMed Scopus (61) Google Scholar Poor blood sugar control in liver transplant recipients has been linked to increased risk of liver allograft rejection, surgical site infection and increased mortality.49Wallia A. Parikh N.D. Molitch M.E. et al.Posttransplant hyperglycemia is associated with increased risk of liver allograft rejection.Transplantation. 2010; 89: 222-226Crossref PubMed Scopus (65) Google Scholar, 50Park C. Hsu C. Neelakanta G. et al.Severe intraoperative hyperglycemia is independently associated with surgical site infection after liver transplantation.Transplantation. 2009; 87: 1031-1036Crossref PubMed Scopus (111) Google Scholar While normal glucose metabolism, (with increased insulin requirement), could be a sign of a well functioning allograft post transplant. Hypoglycemia can be an ominous sign of compromised liver recovery.51Marik P.E. Preiser J.C. Towards understanding tight glycemic control in the ICU: a systematic review and meta-analysis.Chest. 2009; 137: 544-551Crossref PubMed Scopus (279) Google Scholar Hence frequent plasma glucose monitoring and blood sugar control become important. Although tight blood sugar control has been linked to improved outcomes (between 80 and 120 mg/dL), this is associated with increased risk of hypoglycemia in the presence of reduced glucose reserve. A modest target of blood glucose of ≤150 mg/dL is therefore advised.52Finfer S. Chittock D.R. Su S.Y. et al.Intensive versus conventional glucose control in critically ill patients.N Engl J Med. 2009; 360: 1283-1297Crossref PubMed Scopus (3748) Google Scholar Dyselec" @default.
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• W2092405397 modified "2023-09-26" @default.
• W2092405397 title "Perioperative Monitoring in Liver Transplant Patients" @default.
• W2092405397 cites W1576723918 @default.
• W2092405397 cites W1664488112 @default.
• W2092405397 cites W1911650660 @default.
• W2092405397 cites W1957879335 @default.
• W2092405397 cites W1965758371 @default.
• W2092405397 cites W1966688519 @default.
• W2092405397 cites W1972940396 @default.
• W2092405397 cites W1976852542 @default.
• W2092405397 cites W1977535379 @default.
• W2092405397 cites W1979296830 @default.
• W2092405397 cites W1981044626 @default.
• W2092405397 cites W1986585972 @default.
• W2092405397 cites W1988979826 @default.
• W2092405397 cites W1989235460 @default.
• W2092405397 cites W1989626641 @default.
• W2092405397 cites W1990040446 @default.
• W2092405397 cites W1991843023 @default.
• W2092405397 cites W1995753534 @default.
• W2092405397 cites W2008511449 @default.
• W2092405397 cites W2011320908 @default.
• W2092405397 cites W2012631817 @default.
• W2092405397 cites W2014052449 @default.
• W2092405397 cites W2015597573 @default.
• W2092405397 cites W2015943523 @default.
• W2092405397 cites W2017378202 @default.
• W2092405397 cites W2019039354 @default.
• W2092405397 cites W2022255136 @default.
• W2092405397 cites W2022746362 @default.
• W2092405397 cites W2023502981 @default.
• W2092405397 cites W2025778465 @default.
• W2092405397 cites W2030431973 @default.
• W2092405397 cites W2032050251 @default.
• W2092405397 cites W2043958421 @default.
• W2092405397 cites W2044173767 @default.
• W2092405397 cites W2047551117 @default.
• W2092405397 cites W2050036553 @default.
• W2092405397 cites W2056064934 @default.
• W2092405397 cites W2056117044 @default.
• W2092405397 cites W2064895546 @default.
• W2092405397 cites W2064906307 @default.
• W2092405397 cites W2069670773 @default.
• W2092405397 cites W2070365535 @default.
• W2092405397 cites W2072959007 @default.
• W2092405397 cites W2074334099 @default.
• W2092405397 cites W2074494868 @default.
• W2092405397 cites W2078088865 @default.
• W2092405397 cites W2081652464 @default.
• W2092405397 cites W2083012440 @default.
• W2092405397 cites W2085360318 @default.
• W2092405397 cites W2094463755 @default.
• W2092405397 cites W2099713386 @default.
• W2092405397 cites W2102180587 @default.
• W2092405397 cites W2102437151 @default.
• W2092405397 cites W2110600155 @default.
• W2092405397 cites W2112600396 @default.
• W2092405397 cites W2133124045 @default.
• W2092405397 cites W2134773385 @default.
• W2092405397 cites W2135319607 @default.
• W2092405397 cites W2135878370 @default.
• W2092405397 cites W2137164304 @default.
• W2092405397 cites W2145053281 @default.
• W2092405397 cites W2146085139 @default.
• W2092405397 cites W2146351148 @default.
• W2092405397 cites W2151364083 @default.
• W2092405397 cites W2153411227 @default.
• W2092405397 cites W2154925467 @default.
• W2092405397 cites W2161109243 @default.
• W2092405397 cites W2166428296 @default.
• W2092405397 cites W2183370948 @default.
• W2092405397 cites W2321117006 @default.
• W2092405397 cites W2407835226 @default.
• W2092405397 cites W2412844093 @default.
• W2092405397 cites W2415005139 @default.
• W2092405397 cites W4233184002 @default.
• W2092405397 cites W4237200689 @default.
• W2092405397 cites W4239840847 @default.
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