This document summarizes the homeostatic changes observed during anesthesia for liver transplantation from cadaveric donors at Viet Duc Hospital. It presents data on 16 transplant patients, including characteristics, surgical details, and biochemical and physiological measurements at various timepoints before, during, and after the procedure. Significant changes were seen in liver enzymes, bilirubin, electrolytes, lactate, INR, hemoglobin, blood gas values between the preanhepatic, anhepatic and reperfusion phases of the surgery. The study concludes that homeostasis is dramatically impacted at different stages of the liver transplant operation.

1. HOMEOSTATIC CHANGES
DURING ANESTHESIA FOR
LIVER TRANSPLANTATION
FROM CADAVERIC DONOR
AT VIET DUC HOSPITAL
Presenter: Nguyen Huu Hoang MD

2. INTRODUCTION
 1967: The first liver transplant in the world
Thomas Starzl and Christian Barnard
 2007: The first liver transplant at Viet Duc
hospital
 2010: The first liver transplant from dead
brain donor at Viet Duc hospital
 Now: dozens of successful cases
 Intraoperative: biochemical, blood count,
coagulation, blood gas changed dramatically in
each phase of operation

3. OBJECTS AND METHODS
 16 liver transplant patients from cadaveric
donor
 Anesthesia Protocol:
 induction: propopol, Fentanyl/sufentanyl,
suxamethonium,
 maintain: isoflurance/ sevoflurance,
fentanyl/sufentanyl, atracium.
 Mechanical vent: Vt = 10ml/kg f: 10-12 lần/p
 EtCO2 35-40mmHg.

4. OBJECTS AND METHODS
 Monitor: ECG, SpO2, EtCO2,
 A-line:
 Right radial: monitor IBP
 Left radial : Blood samples
 Monitor CO: Swan-Ganz or PiCCO2
 Blood samples : biochemical, blood count, coagulation,
blood gas
 T1: 30 minutes after induction
 T2: dissection phase
 T3: anhepatic phase
 T4: 1minute after reperfusion
 T5: 5minutes after reperfusion
 T6: 60minutes after reperfusion
 T7: at the end of operation

5. RESULTS AND DISCUSSION
Table 1: Patient characteristics
Parameters Min ÷ Max
age (year) 52,5 ± 7,7 38 - 64
Male/female 16(100%)/0(0%)
Height(cm) 166,5 ± 4,8 160-178
Weight(kg) 63,8±8,6 52,5-78
BSA(m2) 1,71±0,14 1,53-1,96
Cirrhosis 3(18,7%)
Diagnose
HCC 13(81,3%)
SD 9,5±3,5 6-17
MELD Score <10
≥ 10
10(62,5%)
6(37,5%)
SD 6,0 ± 1,3 5-9
Child-Push
A/B/C(n) 11/5/0
Swan-Ganz 14(87,5%)
CO
PiCCO2 2(12,5%)
CPB (n) 1(6,25%)

6. RESULTS AND DISCUSSION
Table 2: Anesthsia, surgery duration and fluid infusion intraoperation
Parameters SD Min ÷ Max
Induction(min) 65,6±22,2 40-130
Surgery duration(min) 526±153 380-1050
Time from induction to
extubation (min) 1187±476 550-2220
crystalloid (ml) 5293±1831 2000-8500
Total albumin 20% (ml) 628±227 200-1000
RBC (ml) 1390±1064 0-4000
Plasma (ml) 1512±554 625-2500
Platelet (ml) 609±228 250-1000
Urine output (ml) 1646±606 900-3000

7. RESULTS AND DISCUSSION
900
800
700
600
500
400
300
200
100
0
* *
*
*
* *
*
*
U/l
T1 T2 T3 T4 T5 T6 T7
GOT GPT
Figure 1: Hepatic enzyme changes intraoperative

8. RESULTS AND DISCUSSION
60
50
40
30
20
10
0
* *
* *
* *
T1 T2 T3 T4 T5 T6 T7
Total Bilirubin Direct Bilirubin
Figure 2: Bilirubin changes intraoperative

9. RESULTS AND DISCUSSION
mmol/l *
16
14
12
10
0 2 4
6 8
* *
*
T1 T2 T3 T4 T5 T6 T7
Glucose Kali Canxi
Figure 3: blood glucose and electrolytes changes intraoperative

10. RESULTS AND DISCUSSION
Figure 4: Intraoperative blood lactat levels
6
5
4
2 3
1
0
T1 T2 T3 T4 T5 T6 T7
Lactat
*
* *
*
*
mmol/l

11. RESULTS AND DISCUSSION
* * * * INR
Figure 5: Intraoperative INR changes
2
1.5
1
0.5
0
T1 T2 T3 T4 T5 T6 T7

12. RESULTS AND DISCUSSION
Figure 6: Intraoperative hemoglobin changes
140
120
100
80
60
40
20
0
T1 T2 T3 T4 T5 T6 T7
Hb
* * * *
g/l

13. RESULTS AND DISCUSSION
Table 3: Blood gas changes intraoperative
Parameters T1 T2 T3 T4 T5 T6 T7 p
pH 7,48±0,12 7,47±0,04 7,43±0,04 7,36±0,06 7,38±0,05 7,41±0,04 7,45±0,05 p 3,4,5<0,001
PaO2 208±65 199±39 205±82 279±105 315±101 192±39 202±66 p3,4,5<0,05
PaCO2 31±5 37±6 35±4 39±5 38±3 40±6 38±9 p3,4,5,6<0,05
P/F 335±66 338±66 347±126 422±125 533±157 341±50 388±110 p3,4,5 <0,05

14. CONCLUSION
 Homeostatic changed significantly between
preanhepatic, anhepatic and reperfution
phase

15. THANKYOU