Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation

AIM To assess the value of the mean systemic-to-pulmonary artery pressure(MAP/m PAP) ratio for predicting outcomes following orthotopic liver transplant(OLT). METHODS A retrospective data analysis was performed and data(mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit(ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications. A total of 91 patients were included in the data analysis. Based on the intraoperative course of the MAP/m PAP ratio, 2 hemodynamic responses were identified: Group 1(MAP/m PAP ratio increase during anhepatic period with postreperfusion recovery, n = 66); and Group 2(MAP/m PAP ratio with no change during anhepatic period or decreased without recovery, n = 25). RESULTS The main finding was that the lack of increased MAP/m PAP ratio in the anhepatic period was associated with:(1) longer intubation times; and(2) prolonged ICU stays and total hospitalization time, when compared to patients with an increase in MAP/m PAP ratio during the anhepatic period. CONCLUSION The data from this retrospective study should raise awareness to the mean systemic to pulmonary artery pressure ratio as a potential indicator for poor outcome after OLT. Further prospective studies are needed for validation.