Association Between the Use of Pulmonary Artery Catheter and Clinical Outcomes After Liver Transplantation

Study Overview
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Brief Summary
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The investigators attempted to evaluate whether the use of PAC is associated with better clinical outcomes after liver transplantation compared with the case without PAC.

Detailed Description
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Pulmonary artery catheter (PAC) has been used for advanced hemodynamic monitoring during liver transplantation. However, recent advances in less invasive monitoring could provide continuous cardiac output monitoring by arterial waveform analysis. Using this technology, stroke volume variation (SVV) is monitored as a preload index. Calculated systemic vascular resistance (SVR) can be monitored if central venous pressure (CVP) is provided. Therefore, this less invasive form of hemodynamic monitoring may replace the PAC. The investigators attempted to evaluate whether the use of PAC is associated with better clinical outcomes after liver transplantation compared with the case without PAC.

Official Title
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Association Between the Use of Pulmonary Artery Catheter and Clinical Outcomes After Liver Transplantation

Conditions
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End Stage Liver DIsease, Liver Transplant; Complications, Liver Cirrhosis, Liver Diseases

Intervention / Treatment
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* Device: Pulmonary artery catheter (Edward Lifesciences, Irvine, California, USA)
* Device: FloTrac Vigileo system (EV1000 clinical platform, Edward Lifesciences, Irvine, California, USA)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients who underwent living or deceased donor liver transplantation at our tertiary care university hospital between 2006 and 2022 Exclusion Criteria: Patients with baseline renal dysfunction Missing baseline or outcome variables Retransplantation Patients who received intraoperative transesophageal echocardiography (TEE) monitoring

Ages Eligible for Study
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Minimum Age: 20 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pulmonary artery catheter group<br>Patients who received pulmonary artery catheter insertion and hemodynamic monitoring by PAC-derived parameters | Device: Pulmonary artery catheter (Edward Lifesciences, Irvine, California, USA)<br>* PAC was inserted and connected to a continuous cardiac output monitor (Vigilance I from 2006 to 2012; Vigilance II from 2012 to 2022, Edward Lifesciences, Irvine, USA)<br>|
| Non-pulmonary artery catheter group<br>Patients who did not received pulmonary artery catheter insertion and were monitored with Flo-Trac FloTrac Vigileo | Device: FloTrac Vigileo system (EV1000 clinical platform, Edward Lifesciences, Irvine, California, USA)<br>* Without PAC, monitoring with FloTrac Vigileo system (EV1000 clinical platform, Edward Lifesciences, Irvine, California, USA) was performed for continuous cardiac output monitoring.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with acute kidney injury | Acute kidney injury (AKI) was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, which was defined according to the greatest change in serum creatinine level during the postoperative seven days (Stage 1: more than 1.5-fold; stage 2: more than 2-fold; stage 3: more than 3-fold increase from baseline level or increase in serum creatinine to ≥ 4.0 mg/dL or the initiation of renal replacement therapy). The most recent serum creatinine level measured before surgery was collected as a baseline value. | the first 7 postoperative days | 
| Number of Participants with early allograft dysfunction | Early allograft dysfunction (EAD) was defined when one or more of the following are present within the first 7 postoperative days: total bilirubin ≥ 10 mg/dL, prothrombin time: international normalized ratio ≥ 1.6, or aspartate or alanine transaminase > 2000 IU/L | the first 7 postoperative days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In-hospital mortality | all-cause mortality during hospitalization | the first month after admission | 
| One-year mortality | all-cause mortality during one year after transplantation | one year after transplantation | 
| Length of intensive care unit (ICU) stay | Length of intensive care unit stay after transplantation | the first month after admission | 
| Length of hospital stay | Length of hospital stay after transplantation | the first month after admission |