Evaluation of hepatic vessels by transesophageal echocardiography during living donor liver transplantation.

Not yet recruiting

Brief Summary: Liver transplantation is considered a standard of care and life-saving procedure for patients suffering from end-stage liver disease (ESLD). Due to cirrhotic cardiomyopathy, these patients usually have cardiac dysfunction which is not detected on routine testing but manifests during stress conditions of surgery. The expanding role of transesophageal echocardiography (TEE) in intraoperative monitoring is now increasing gradually and it is being used away from the context of cardiac surgeries alone. The American Association for anesthetists on liver diseases has recommended that TEE should be used for all orthotropic liver transplant cases. Similarly, the European association of echocardiography has also recommended for use of TEE in all liver transplant cases. TEE can be used not only to monitor cardiac changes but can also give valuable information about other organs such as the lungs and liver. In a case report by Khurmi et al, they used TEE to diagnose hepatic venous and IVC thrombus intra-operatively during liver transplant surgery. The anatomic proximity of the distal esophagus and gastric antrum to the hepatic vein, portal vein, and inferior vena cava make TEE an idol monitor for their proper assessment during liver transplant surgery. Hence, in this study, we aim to evaluate the hepatic vein, portal vein, and inferior vena cava by TEE during living donor liver transplant surgery.

Recruitment & Eligibility

Inclusion Criteria

All patients undergoing living donor liver transplantation.

Exclusion Criteria

Previous history of esophageal pathology like stricture, malignancy, diverticulum, laceration or history of previous esophageal surgery.
Esophageal varices > grade 2, gastric varices or active esophagitis.
History of recent upper gastro-intestinal bleed (within 1 month).
History of variceal banding within last month 5.

Primary Outcome Measures

Name	Time	Method
To evaluate portal vein, hepatic vein and IVC flow velocities using TEE immediately after the reperfusion during live donor liver transplant surgery.	Baseline, 4 hours, 8 hours, 12 hours

Secondary Outcome Measures

Name	Time	Method
To find out the angle on TEE at which portal vein, hepatic vein and ivc are seen	24 Hours
Any major finding on TEE during liver transplantation	24 Hours
Any complication related to TEE	48 Hours

Locations (1): Institute of Liver and Biliary sciences
🇮🇳
South, DELHI, India
Institute of Liver and Biliary sciences
🇮🇳South, DELHI, India
Dr Gaurav Sindwani
Principal investigator
91872808989
drsindwani25@gmail.com