Recent Advances in TransplantationLiver transplantationAdenosine Increases Hepatic Artery Flow in Liver Transplant Recipients: A Pilot Study

- In this work, we have for the first time demonstrated that direct adenosine infusion the HA could increase HAF in cadaveric liver transplant recipients without significant systemic side effects.
- This study will play a crucial role in patients planning to perform living donor liver transplantation or extended hepatectomy which may occur SFSS because of insufficient remnant liver volume.

BackgroundThe aim of this study was to assess the effect of low-dose adenosine on hepatic artery flow (HAF) when administered intraoperatively by continuous infusion.Materials and MethodsBetween January 2009 and August 2009, 74 patients underwent orthotopic liver transplantation (OLT). Ten patients were enrolled for adenosine treatment, and 64 non-study patients served as controls. After arterial reperfusion, a 16-G central venous catheter was placed in the gastroduodenal artery, and adenosine was continuously infused at doses ranging from 0.7 to 2.8 μg/kg/min for 30 min. HAF and portal vein flow were measured using a transit time flow meter before adenosine infusion, during infusion, and 10 min after infusion. Liver function tests were monitored routinely, duplex ultrasonography was performed on postoperative day 1, and the hepatic artery resistive index measured. The patients were followed for 1 year.ResultsAdenosine significantly increased HAF at doses from 0.7 to 2.8 μg/kg/min. The smallest increase in HAF was 24% above the baseline; in 80% of patients, the increase in HAF was >50% of the baseline values. In 2 patients, HAF was increased by >300%. The dosing started at 0.7 μg/kg/min, and 6 of 10 patients responded. Three patients required an increase to 1.4 μg/kg/min. Doses >2.8 μg/kg/min did not further increase HAF. One patient showed a minimal response regardless of the dose. There were no differences between the adenosine group and control group with respect to liver function (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and International Normalized Ratio), platelet count on POD2, hepatic artery resistive index, and post-transplant length of stay, intensive care days, or 1-year patient survival rates.ConclusionsThis pilot study established that adenosine administered directly into the hepatic artery produces a similar effect on HAF in cadaveric liver transplant recipients to that found in the laboratory without producing systemic side effects.