Transcranial Doppler During Liver Transplantation

Study Overview
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Brief Summary
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This is a prospective study that would investigate the transcranial doppler (TCD) changes during the living donor liver transplantation and the association between the TCD changes and the post-transplant neurological complications.

Detailed Description
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Objectives: Participants & Setting: Intervention & Measurements: Sample size:

Official Title
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Transcranial Doppler and Neurological Complications After Liver Transplantation

Conditions
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Liver Transplantation, Ultrasonography, Doppler, Transcranial, Complication, Postoperative, Neurologic Deficits

Intervention / Treatment
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* Diagnostic Test: Transcranial Doppler


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all patients scheduled for living donor liver transplantation for whatever the indication at Gastrointestinal surgery center (GISC) Exclusion Criteria: Patients with coexisting neuropsychiatric or cerebrovascular disorders or those who have a history of head trauma or brain surgery

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Intervention Model: Single Group Assignment
Interventional Model Description: A single-arm trial involving 100 patients undergoing living donor liver transplantation; all will be examined using transcranial doppler to find out its predictive value on post-transplant neurological deficits.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TCD arm<br>All patients will be evaluated with TCD for prediction of the post-transplant neurological complications | Diagnostic Test: Transcranial Doppler<br>* Transcranial Doppler-derived parameters; pulsatility index (PI), resistance index (RI), mean flow velocity (Vmean) will be recorded before induction of anesthesia (T1). After induction, TCD parameters, Hemodynamic variables including heart rate (HR), invasive mean arterial blood pressure (MAP), and central venous pressure (CVP) together with Arterial blood gases (ABG analysis with values of PH, PCO2, PO2, blood oxygen saturation SO2 and bicarbonate HCO3), end-tidal carbon dioxide (ETCO2) and body temperature will be recorded too. Just before skin incision (T2), at the end of anhepatic phase 5 minutes before reperfusion (T3), 5 minutes after reperfusion (T4) and at the end of surgery (T5). Postoperatively at ICU, TCD parameters, Hemodynamic variables, and ABG will be obtained 24 hours postoperative (T6) and at discharge from ICU (T7).<br>* Other names: TCD;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-transplant Neurological Complication | incidence of Neurological Complication as a composite outcome (tremors, seizures, demyelination, posterior reversible encephalopathy syndrome, stroke) | 28 days after transplantation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| flow patterns throughout the transplant surgery and in the ICU | normal, hyperemic, low-flow, or vasospastic flow by TCD | intraoperative and 7 days after transplantion |