Hemodynamic Recovery Following Postreperfusion Syndrome in Liver Transplantation

Fukazawa, Kyota; Yamada, Yosuke; Gologorsky, Edward; Arheart, Kristopher L.; Pretto, Ernesto A.

doi:10.1053/j.jvca.2014.02.017

Cited by 55 publications

(72 citation statements)

References 22 publications

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“…and Chung et al . showed an early increase in bilirubin . In our study, although the clear effect of ALA on the lower incidence of the PRS, this was not associated with lower levels of plasma bilirubin and ALT but with plasma alarmins.…”

Section: Discussioncontrasting

confidence: 62%

α-lipoic acid reduces postreperfusion syndrome in human liver transplantation - a pilot study

et al. 2018

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A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-lipoic acid (ALA) in liver transplantation (LT). The grafts were randomized to receive ALA or placebo before the cold ischemia time. Furthermore, patients transplanted with the ALA-perfused graft received 600 mg of intravenous ALA, while patients with the nonperfused graft received the placebo just before graft reperfusion. Hepatic biopsy was performed 2 h postreperfusion. Blood samples were collected before, during and 1 and 2 days after reperfusion. Quantitative polymerase chain reaction (qPCR) analysis was performed on biopsies to assess genes involved in the response to hypoxia, apoptosis, cell growth, survival and proliferation, cytokine production and tissue damage protection. Nine of 40 patients developed postreperfusion syndrome (PRS), but seven of them belonged to the control group. There was a decrease in PHD2 and an increase in alpha subunit of hypoxia-inducible factor-1 (HIF-1α) and baculoviral IAP repeat containing 2 (Birc2) transcript levels in the biopsies from the ALA-treated versus the control group of patients. Additionally, plasma levels of alarmins were lower in ALA-treated patients than control patients, which suggests that ALA-treated grafts are less inflammatory than untreated grafts. These results showed that ALA is safe for use in LT, induces gene changes that protect against hypoxia and oxidative stress and reduces the appearance of PRS.

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Section: Discussioncontrasting

confidence: 62%

α-lipoic acid reduces postreperfusion syndrome in human liver transplantation - a pilot study

et al. 2018

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“…Donor age and donor risk index (DRI) are also reported being associated with the development of PRS[105] and with greater haemodynamic instability and delayed intra-operative haemodynamic recovery. A role for poor tolerance of ischemia-reperfusion phenomenon or age-related steatotic parenchymal changes (senescence) has been advocated[105].…”

Section: Specific Intra-operative Risk Factors For Post-lt Prs-inducementioning

confidence: 99%

“…A role for poor tolerance of ischemia-reperfusion phenomenon or age-related steatotic parenchymal changes (senescence) has been advocated[105]. …”

Section: Specific Intra-operative Risk Factors For Post-lt Prs-inducementioning

confidence: 99%

Acute kidney injury and post-reperfusion syndrome in liver transplantation

Umbro¹,

Tinti²,

Scalera³

et al. 2016

WJG

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In the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney injury AND DCD AND liver transplantation”. Accordingly, three out of five studies were selected for our purpose.

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“…While detailed and expensive cardiac evaluation is routinely performed on patients before OLT, the extent of cirrhotic cardiomyopathy and biventricular dysfunction is often underestimated[5,6]. Intraoperatively, due to circumstances related to advanced multi-organ disease, limited cardiac reserve and procedural related stressors including blood loss, fluid shifts, acidosis, or hypothermia, the patient may present more hemodynamic challenges than anticipated[7]. …”

Section: Introductionmentioning

confidence: 99%

Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation

Rebel¹,

Nguyen²,

Bauer³

et al. 2016

WJH

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AIMTo assess the value of the mean systemic-to-pulmonary artery pressure (MAP/mPAP) ratio for predicting outcomes following orthotopic liver transplant (OLT).METHODSA retrospective data analysis was performed and data (mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit (ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications. A total of 91 patients were included in the data analysis. Based on the intraoperative course of the MAP/mPAP ratio, 2 hemodynamic responses were identified: Group 1 (MAP/mPAP ratio increase during anhepatic period with postreperfusion recovery, n = 66); and Group 2 (MAP/mPAP ratio with no change during anhepatic period or decreased without recovery, n = 25).RESULTSThe main finding was that the lack of increased MAP/mPAP ratio in the anhepatic period was associated with: (1) longer intubation times; and (2) prolonged ICU stays and total hospitalization time, when compared to patients with an increase in MAP/mPAP ratio during the anhepatic period.CONCLUSIONThe data from this retrospective study should raise awareness to the mean systemic to pulmonary artery pressure ratio as a potential indicator for poor outcome after OLT. Further prospective studies are needed for validation.

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Hemodynamic Recovery Following Postreperfusion Syndrome in Liver Transplantation

Cited by 55 publications

References 22 publications

α-lipoic acid reduces postreperfusion syndrome in human liver transplantation - a pilot study

α-lipoic acid reduces postreperfusion syndrome in human liver transplantation - a pilot study

Acute kidney injury and post-reperfusion syndrome in liver transplantation

Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation

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