Comparison Of Perioperative Anesthetic Management For Adults Undergoning Living Donor Liver Transplantation And Whole-organ Orthotopic Liver Transplantation

Objective:To investigate the perioperative anesthetic management during the procedure of adult living donor liver transplantation and whole-organ orthotopic liver transplantation. Mathods:Twenty-two patients undergoing liver transplantation from June 2009 to August 2009 in the First Affiliated Hospotal of Zhejiang University College of Medicine were retrospetively studied.There were ten patients who underwent living donor liver transplantation and twelve patients with whole-organ orthotopic liver transplantation. During the operation,Blood gas analyse,coagulation function and biochemistry tests were detected regularly during the operation and 1-day postoperation.Results: The MELD score (29.00±7.58) and surgery time (513.80±105.11) of patients who accecpted living donor liver transplantation were both significantly higher than that of patients who accepted whole-organ orthotopic liver transplantation (21.00±4.57,379.91±65.73)(P<0.01).It was found that PH of both were obviously decreased in anhepatic phase and neohepatic phase.(Compared with pre-anhepatic phase,P<0.05).Moreover,the whole-organ orthotopic liver transplantation patients presented more serious metabolic acidosis(7.28±0.07) than living donor liver transplantation (7.34±0.06, P<0.05).The level of Glu,Lac,ALT,AST in living donor liver transplantation and the whole-organ orthotopic liver transplantation patients increased gradually,especially Glu and Lac of both in anhepatic phase and neohepatic phase,and Glu,ALT of the latter (236.33±43.80,724±481) increased more significantly than that of the former(177.30±28.39,245±358) (P<0.05).But there were no difference between the two in K+,Ca2+,Lac,AST at every phase. TB,GGT in both patients presented descending tendency,and there were obvious difference between two at preoperation phase,pre-anhepatic phase and neohepatic phase.For the renal function,the level of Cr and BUN of whole-organ orthotopic liver transplantation patients incresed more obviously at 1-day postoperation phase (P<0.05),but there were no difference between two at every phase. Conclusion: Compared with patients undergoing whole-organ orthotopic liver transplantation patients undergoing living donor liver transplantation were generally more serious before operation and needed longer surgery time.However,in general there were no difference between the two groups neither in perioperative Blood gas analyse coagulation function,hepatic function and renal function nor in 1-day postoperative hepatic function and renal function.