Diagnosis, Incidence, Predictors and Management of Postreperfusion Syndrome in Pediatric Deceased Donor Liver Transplantation: A Single-Center Study

Zhang, Liang; Tian, Ming; Xue, Fu‐Shan; Zhu, Zhi‐Jun

doi:10.12659/aot.909050

Cited by 13 publications

(25 citation statements)

References 27 publications

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“…Orthotopic Liver transplantation (OLT) is a life-saving procedure and the treatment of choice for severe chronic liver disease and acute liver failure [ 1 , 2 ]. Post reperfusion syndrome (PRS) is a relatively common but life-threatening complication during OLT with a prevalence of 3.6–81% [ 3 – 6 ]. The wide range prevalence of PRS in the previous studies occurs due to the differences in the description of PRS, treatment strategies, and surgical techniques [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study

et al. 2022

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Background Post reperfusion syndrome (PRS) is a relatively common and life-threatening complication during orthotopic liver transplantation (OLT). It is associated with poor patient and transplanted liver outcomes. Objective This study aimed to compare the risk factors of PRS during OLT. Design Clinical-epidemiological observational retrospective study. Setting We gathered the records of patients who underwent OLT in 3 years, from May 22, 2016, to May 22, 2019, in Namazi and Bu-Ali Sina organ transplantation hospitals. Patients In this study, we assessed 1182 patients who underwent OLT. Patients were divided into two groups based on the presence or absence of PRS. Main outcome measures Diagnosing the predictors of PRS was the primary outcome of this study. Results Results showed that age > 60 years, Child-Pugh scores C, higher Model End Stage liver disease score, and preoperative sodium < 130 mmol/l (parameters of the liver recipient), increase in cold ischemic time (the donors’ parameters), and the classical technique (the surgical parameters) were the strong predictors of PRS. Conclusions The results indicated that underlying liver disease was not the predictor of PRS in the presence of other risk factors; therefore, clinicians have to consider these risk factors in patients undergoing OLT.

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Section: Introductionmentioning

confidence: 99%

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study

et al. 2022

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“…All the patients receiving the basic anesthesia protocol from our institution were described previously [ 10 ]. However, it was not until 2017 that the anesthetist-in-charge began to more liberally choose to administer DEX as an anesthetic adjuvant.…”

Section: Methodsmentioning

confidence: 99%

“…Secondary outcomes included the peak blood urea nitrogen (BUN) and serum creatinine (Cr) levels during the first week after LT, the incidence of the severe postreperfusion syndrome (PRS) and acute kidney injury (AKI), and the durations of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. The extent of severe PRS and AKI were evaluated using the Peking criteria [ 10 ] and the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study

Zhang

Cui

et al. 2021

Ann Transplant

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Background Dexmedetomidine (DEX) attenuates hepatic ischemia-reperfusion injury (HIRI) in adult liver transplantation (LT), but its effects on postoperative liver graft function in pediatric LT remain unclear. We sought to investigate whether intraoperative DEX administration was associated with improved liver graft function in pediatric LT recipients. It was hypothesized that DEX administration was associated with reduced HIRI and improved liver graft function. Material/Methods From November 2015 to May 2020, 54 deceased pediatric LT recipients were categorized into a control group and a DEX group. Intraoperatively, the DEX group received an additional infusion of DEX at 0.4 μg/kg/h from incision to the end of the operation in comparison with the control group. Preoperative, intraoperative, and postoperative data were reviewed. Postoperative liver enzyme levels and HIRI severity were assessed and compared. Independent risk factors for HIRI were determined by multivariate logistic regression analysis using a stepwise forward conditional method. Results We enrolled 28 and 26 patients in the DEX and control groups, respectively. Patients in the DEX group exhibited a reduced incidence of moderate-to-severe HIRI (88.5% vs 60.7%, P =0.020) and decreased level of serum alanine aminotransferase (median [interquartile range]: 407 [230–826] vs 714 [527–1492] IU/L, P =0.048) compared with the controls. Binary logistic analysis revealed that longer cold ischemia time (odds ratio [OR]=1.006; 95% confidence interval [CI]=1.000–1.013; P =0.044) and intraoperative DEX use (OR=0.198; 95% CI=0.045–0.878; P =0.033) were independent predictors for moderate-to-severe HIRI. Conclusions Intraoperative low-dose DEX administration was associated with a lower incidence of moderate-to-severe HIRI in pediatric deceased LT. However, further studies are needed to confirm our results and elucidate the underlying mechanisms.

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“…During the anhepatic phase, the inferior vena cava was totally clamped in all cases without the use of VVB. All children were treated according to the standard anesthetic protocol for pediatric LT in our center, and the intraoperative anesthetic data were obtained by reviewing the electronic anesthesia records [ 9 ]. Specifically, preoperative cardiovascular assessment and management algorithms of AGS patients were as follows: Echocardiography was initially performed to evaluate cardiac function and screen-out potential cardiopulmonary malformations, and right heart catheterization would be further employed when there were findings of complex congenital heart disease or elevated pulmonary arterial pressure.…”

Section: Methodsmentioning

confidence: 99%

Pediatric Liver Transplantation for Alagille Syndrome: Anesthetic Evaluation and Perioperative Management

et al. 2020

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Background Alagille syndrome (AGS) is an autosomal dominant hereditary disorder characterized by identifiable abnormalities in the liver, heart, face, skeleton, and eyes. Recently, liver transplantation (LT) has been proposed as a therapeutic strategy for patients with AGS complicated by end-stage liver disease, but clinical experience in performing anesthesia in LT for AGS is still scarce. We aimed to summarize our preliminary experience in the anesthetic management of LT for AGS in this study. Material/Methods We reviewed the cases of 11 patients with AGS who underwent LT from September 2017 to April 2019. Preoperative multi-system comorbidities, intraoperative details, and postoperative outcomes were retrospectively collected and summarized. Results Cardiopulmonary abnormalities were common (81.8%) in AGS patients before LT, and the most frequent comorbidity was pulmonary artery stenosis. After careful anesthetic evaluation and perioperative management, all patients survived during the perioperative period without significant cardiovascular complications. However, there was an unexpectedly high prevalence of surgical complications and re-operations in AGS patients compared to biliary atresia recipients (54.5% vs . 22.4%, P=0.031; and 45.5% vs . 15.3%, P=0.028, respectively). Conclusions Perioperative management of LT for AGS patients can be particularly challenging, requiring a full understanding of the pathophysiology, as well as a careful preoperative evaluation of the multi-system comorbidities. The high prevalence of postoperative surgical complications should be a matter of concern.

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Diagnosis, Incidence, Predictors and Management of Postreperfusion Syndrome in Pediatric Deceased Donor Liver Transplantation: A Single-Center Study

Cited by 13 publications

References 27 publications

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study

Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study

Pediatric Liver Transplantation for Alagille Syndrome: Anesthetic Evaluation and Perioperative Management

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