Arrhythmogenic potential develops rapidly at graft reperfusion before the start of hypotension during living-donor liver transplantation

Abstract

BackgroundDetailed profiles of acute hypothermia and electrocardiographic (ECG) manifestations of arrhythmogenicity were examined to analyze acute hypothermia and ventricular arrhythmogenic potential immediately after portal vein unclamping (PVU) in living-donor liver transplantation (LT).MethodsWe retrospectively analyzed electronically archived medical records (n = 148) of beat-to-beat ECG, arterial pressure waveforms, and blood temperature (BT) from Swan-Ganz catheters in patients undergoing living-donor LT. The ECG data analyzed were selected from the start of BT drop to the initiation of systolic hypotension after PVU.ResultsOn reperfusion, acute hypothermia of < 34℃, < 33℃ and < 32℃ developed in 75.0%, 37.2% and 11.5% of patients, respectively. BT decreased from 35.0℃ ± 0.8℃ to 33.3℃ ± 1.0℃ (range 35.8℃–30.5℃). The median time to nadir of BT was 10 s after PVU. Difference in BT (ΔBT) was weakly correlated with graft-recipient weight ratio (GRWR; r = 0.22, P = 0.008). Compared to baseline, arrhythmogenicity indices such as corrected QT (QTc), Tp-e (T wave peak to end) interval, and Tp-e/QTc ratio were prolonged (P < 0.001 each). ST height decreased and T amplitude increased (P < 0.001 each). However, no correlation was found between ΔBT and arrhythmogenic indices.ConclusionsIn living-donor LT, regardless of extent of BT drop, ventricular arrhythmogenic potential developed immediately after PVU prior to occurrence of systolic hypotension.

Prevalent metabolic derangement and severe thrombocytopenia in ABO-incompatible liver recipients with pre-transplant plasma exchange

“…In addition, our results revealed a higher rate of hypomagnesaemia in ABO-I LDLT recipients. Close monitoring and tight control of both hypokalaemia and hypomagnesaemia with appropriate management may be mandatory for preventing fatal arrhythmias in ABO-I LDLT recipients, given the possibility of torsades de pointes associated with hypotension and electrolyte disturbances in cirrhotic patients with severe QTc prolongation 33 and with progressively prolonged QTc intervals during the pre-anhepatic and anhepatic phases 31 , 34 .…”

Longer storage of red blood cells does not affect mortality in transfused liver transplant recipients

“…Therefore, in our data, allogeneic WBC‐related effects were unlikely to raise a significant bias. The timing of irradiation is another issue to consider because elevated potassium levels in RBC units stored for long periods following irradiation can lead to a deleterious impact on a reperfused graft . In this regard, the use of RBC units stored for more than 24 hours after irradiation were prohibited.…”

“…The timing of irradiation is another issue to consider because elevated potassium levels in RBC units stored for long periods following irradiation can lead to a deleterious impact on a reperfused graft. 29,30 In this regard, the use of RBC units stored for more than 24 hours after irradiation were prohibited. Furthermore, RBC units stored for less than 4 days were excluded because these units were determined to increase the risk of posttransplant mortality significantly based on our liver transplant database.…”

Cardiovascular dysfunction and liver transplantation

“…In the anhepatic stage, 54% of recipients show marked prolongation of QTc ≥ 500 ms, which may increase the potential for developing severe ventricular dysrhythmias [ 24 ]. Given that arrhythmogenic potential develops rapidly at graft reperfusion just before the start of hypotension during LT [ 25 ], special attention is required to prevent severe arrhythmias in patients with a prolonged QT interval. In this regard, the clinical impact of severe QT prolongation (≥ 500 ms) in the cirrhotic population is an area of further research interest and remains to be established.…”