Gastrointestinal tonometry in liver transplantation offers early diagnosis of graft
dysfunction and directs other necessary therapeutic interventions.
Article: Brito TC da S, Xavier SP de S, Teixeira BP, Silva CE da, Falcão JA, Silva LF da, Santana AGC de, Batista PHM dos SN, Souza e Silva HR de, Lima MI de, Fonseca Neto OCL da.; Tonometria gastrointestinal no perioperatório do transplante hepático: Uma revisão integrativa. Brazilian Journal of Transplantation. 2024, 27:e0424.
Study reveals the importance of gastrointestinal tonometry in monitoring liver transplantation
After a liver transplant, checking that the new organ is functioning properly is crucial. This is usually done by observing signs such as bile production. However, some signs can be misleading, such as bile production in small quantities or with unusual characteristics. Measuring liver enzymes is not useful immediately after transplantation, as they take time to return to normal. Another technique, called indocyanine green (ICG) clearance, can be useful, but its result depends on more factors than just liver function.
Gastric tonometry, on the other hand, is a simple, non-invasive, and low-cost technique that can provide valuable information on splanchnic perfusion (blood supply to the abdominal organs) and the function of the liver graft in liver transplantation (LTx) (Perilli et al., 2014).
But what are the benefits of using gastrointestinal tonometry in the perioperative period of patients undergoing LTx?
In the article "Gastrointestinal tonometry in the perioperative period of liver transplantation: An integrative review", published in the Brazilian Journal of Transplantation (vol. 27, 2024), Tatiany Cíntia da Silva Brito and colleagues sought to answer this question.
To do this, the authors carried out an integrative review of the literature, analyzing data from various studies on the subject. The review followed the PICO strategy, which defined the research question in a structured way, considering the following components: Patient/Problem; Intervention; Comparison; and Outcomes.
Although this article has its limitations due to the scarcity of available publications, which limits its ability to cover a wide range of scientific evidence, gastrointestinal tonometry can be a useful tool for monitoring circulation in the digestive system and liver function during a liver transplant. Measurements of intramural gastric pH (pHi) during surgery and shortly after reperfusion of the liver can help doctors diagnose problems and decide on the best treatment for the patient, as the liver is particularly sensitive to a lack of oxygen. Tonometry can also predict the future viability of the liver with high accuracy and is important from the phase without the liver until the end of surgery. In addition, if the oxygenation of the intestinal tissues is compromised, even with normal blood flow, this suggests the need to investigate other causes of circulation problems during liver transplantation.
Read more (References):
Perilli V, Aceto P, Modesti C, Vitale F, Ciocchetti P, Sacco T, et al. Prediction of poor graft function by means of gastric tonometry in patients undergoing liver transplantation. Ann Hepatol. 2014 jan;13(1):54-9. https://doi.org/10.1016/S1665-2681(19)30904-4
Author
Simone Bacilieri
Links
Brazilian Journal of Transplantation