Is there occult tissue ischemia in chronic end-stage liver disease?

Whether pathological oxygen supply dependency exists in patients with chronic end-stage liver disease (CESLD) is unknown, although the frequently occurring multiorgan dysfunction seen in these patients may be the result of occult tissue ischemia. In this study, 15 adult patients with CESLD were evaluated for the presence of pathological oxygen supply dependency and, thus, occult tissue ischemia before undergoing orthotopic liver transplantation. Whole-body oxygen consumption (Vo(2)) was measured using indirect calorimetry at baseline, at reduced oxygen delivery (Do(2)) using positive end-expiratory pressure, and at increased Do(2) using Volume infusion. As a group, no significant increase or decrease in Vo(2) was observed with changes in Do(2), However, 4 patients showed increases in Vo(2) of 14%, 10.8%, 9.6%, and 8.2% when Do(2) was increased, The study results suggest that pathological oxygen supply dependency is present in a subset of patients with CESLD, and the existence of occult tissue ischemia is speculated. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.