Intraoperative Right Ventricular Systolic Function in Liver Transplantation Recipients: A Prospective Observational Study Using Transesophageal Echocardiography During Living-Donor Liver Transplantation.

OBJECTIVES

This study evaluated dynamic changes in right ventricular (RV) systolic function using transesophageal echocardiography (TEE) during living-donor liver transplantation (LDLT).

DESIGN

Physiological echocardiographic observational study.

SETTING

Single tertiary transplant center.

PARTICIPANTS

Fifty adult patients undergoing LDLT surgery between April 29 and November 14, 2025, were analyzed prospectively.

INTERVENTIONS: Intraoperative TEE was performed at 5 predefined surgical phases to assess RV systolic function using tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), and tissue Doppler-derived systolic (S') velocity. Left ventricular ejection fraction and standard hemodynamic variables were recorded concurrently. The primary outcome was time-dependent change in RV systolic indices.

MEASUREMENTS AND MAIN

RESULTS

The median Model for End-Stage Liver Disease score was 16 (interquartile range, 9), and 38 patients (76%) were men. RV systolic indices demonstrated significant time-dependent variation. TAPSE decreased from 2.15 ± 0.31 cm at baseline to 1.79 ± 0.45 cm during inferior vena cava clamping, with partial recovery to 2.08 ± 0.30 cm by the end of surgery (p < 0.001). Tissue Doppler S' velocity showed a similar pattern (10.58 ± 2.87 to 9.60 ± 2.89 to 11.72 ± 2.56 cm/s, p < 0.001). RVFAC remained relatively preserved but varied significantly across time points (p = 0.014). Left ventricular ejection fraction remained stable (p = 0.224). Hemodynamic changes paralleled RV alterations and responded to vasoactive support.

CONCLUSIONS

Transient reductions in RV systolic indices occurred predominantly during inferior vena cava clamping and improved following reperfusion. Intraoperative TEE allowed serial assessment of these phase-specific RV changes during LDLT.