Hemodynamic changes in splanchnic circulation after orthotopic liver transplantation in patients with liver cirrhosis

Abstract

Background: Liver cirrhosis increases portal vein pressure and alters the splanchnic circulation. With Doppler sonography, we investigated the hemodynamic changes in the portal vein, superior mesenteric artery, hepatic and splenic arteries and spleen size in a group of patients with end-stage liver disease before and after orthotopic liver transplantation (OLT). Methods: Ten patients (seven male, three female; mean age = 48.8 ± 7.6 years) who underwent OLT for liver cirrhosis mainly associated with hepatitis C virus infection completed the study. The control group consisted of 10 patients matched by sex and age who had no gastroenterologic or vascular diseases. All patients underwent duplex Doppler sonography (Toshiba SSA 270A with a 3.5-MHz probe) after 24 h of fasting (baseline) and then 6 and 12 months after OLT. The following parameters, expressed as the mean of three measurements, were evaluated: portal flow velocity (PFV), pulsatility index of the superior mesenteric artery (MAPI), resistance indexes of the hepatic (HARI) and splenic (SARI) arteries, and longitudinal diameter of the spleen (LDS). Results: PFV in the pre-OLT phase was significantly lower in the patients than in the controls (p < 0.0001); it progressively and significantly increased over baseline levels at 6 and 12 months (p < 0.0001), approaching control values. LDS in the pre-OLT phase was significantly higher than in controls (p < 0.0001); after OLT, it decreased significantly compared with baseline values (p < 0.005). The MAPI of patients in the pre-OLT phase was lower than that in controls (p < 0.0001); post-OLT, it progressively increased and reached values that were significantly above baseline at 12 months (p < 0.005). In the pre-OLT phase, the HARI and SARI were significantly higher than in controls (p < 0.04); 6 and 12 months after OLT, those values were significantly below baseline values (p < 0.001), and there was no significant difference from control values. Conclusion: These data show that many of the hemodynamic parameters typical of decompensated cirrhosis improve progressively within 12 months after transplantation.