Comparison of intra-operative haemodynamics and post-operative recovery of recipients in between the right and left liver lobe grafts after adult living donor liver transplantation – An observational study

Liver transplantation is one of themost challenging surgery for an anaesthetist. It is associated with marked haemodynamicchanges which are seen maximally immediately after unclamping of the portalvein and reperfusion. One of the important haemodynamic changes is the postreperfusion syndrome (PRS). It has been defined by two different definitions.First definition was given by aggarwal et al which defined PRS as more than 30% fall in B.P and H.R from baseline within 5 min of reperfusion for more than 1min. Other definition was given by hilmi et al which describes PRS as mild andsignificant. Mild PRS is defined asa decrease of MAP and/or heart rate (HR) not reaching 30% of baseline value,lasting for less than 5 min, and responsive to an intravenous bolus dose ofCalcium Chloride (1 g) and/or epinephrine (≤ 100 mcg) without the need to starta continuous infusion of vasopressors. On the other hand significant PRS wasdefined as a greater hemodynamic instability, a drop in MAP/HR exceeding 30% ofbaseline, asystole or hemodynamically significant arrhythmias; or the need tostart the infusion of vasopressors during the intraoperative period and tocontinue throughout the postoperative period. Other presentations ofsignificant PRS include a prolonged (defined as lasting more than 30 min) orrecurrent (defined as reappearing within 30 min after resolution) fibrinolysisthat requires treatment with antifibrinolytic agents. In adult living donorliver transplantation either left or right liver lobe is used as a graftdepending upon the graft recipient weight ratio (GRWR) or residual liver volumein donor. Right lobe donors are associated with higher complications in donorswhen compared to left lobe donors. On the other hand left lobe donors have morecomplications in recipient when compared to right liver lobe. Haemodynamicchanges after graft implantation can be affected by various factors like donorage, severity of liver and kidney disease, cold ischemia time, left ventriculardysfunction and surgical technique. However as per our literature search effectof liver lobe selection on the haemodynamic changes after reperfusion and onrecipient recovery after liver transplantation have not been studied. Hence this study aims to comparethe intra-operative haemodynamics and post-operative recovery of recipients inbetween the right and left liver lobe grafts after living donor livertransplantation.