Influence of anesthesia type on post-reperfusion syndrome during liver transplantation: a single-center retrospective study

Abstract

Background: Post-reperfusion syndrome (PRS) results in sudden hemodynamic instability following graft reperfusion. Although PRS is known to influence outcomes following liver transplantation, little is known regarding the effects of anesthetics on PRS. This study investigated the association between the type of anesthetic agent and PRS in liver transplantation. Methods: This single-center retrospective cohort study included patients who underwent liver transplantation between June 2016 and December 2019. Patients were divided into sevoflurane and propofol groups according to the anesthetic agent used. Stabilized inverse probability of treatment weighting (IPTW) analysis was performed to investigate the association between PRS identified based on blood pressure recordings and the type of anesthesia. Associations between the anesthetic agent and the duration of hypotension as well as early postoperative outcomes were also investigated.Results: Data were analyzed for 398 patients, 304 (76.4%) and 94 (23.6%) of whom were anesthetized with propofol and sevoflurane, respectively. PRS developed in 40.7% of the 398 patients. Following stabilized IPTW analysis, the association with PRS was lower in the sevoflurane group than in the propofol group (odds ratio, 0.47; P = 0.018). However, there was no association between the type of anesthetic used and early postoperative outcomes. Conclusions: The association of PRS was lower in the sevoflurane group than in the propofol group. However, there was no association between the type of anesthetic and the early postoperative outcomes. Further studies are required to determine the optimal anesthetic for liver transplantation.

Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients

“…recently looked at the effect of anesthetic choice (sevoflurane vs. total intravenous anesthesia with propofol) on the incidence of post‐reperfusion syndrome. The sevoflurane group had a lower incidence of PRS than the propofol group, however they found no differences in early‐postoperative outcomes, including length of stay, graft dysfunction, and kidney injury 18 …”

“…5,7 A second database search using the same criteria occurred at a later date and yielded 10 additional studies that met inclusion criteria, making the final number of selected studies 18. [15][16][17][18][19][20][21][22][23][24] Figure 1 shows a PRISMA diagram detailing the selection process.…”

“…Decreased sympathetic tone 20 Decreased systolic blood pressure 20 Prevention and/or treatment Caval venting 25 Sevoflurane over propofol 18 Retrograde reperfusion 21 Hypothermic oxygenated machine perfusion 22,23 Normothermic machine perfusion 15 Abbreviations: BMI, body mass index; MELD, model for end stage liver disease; PRS, post reperfusion syndrome.…”

“…The sevoflurane group had a lower incidence of PRS than the propofol group, however they found no differences in early-postoperative outcomes, including length of stay, graft dysfunction, and kidney injury. 18 Several studies have evaluated the preventative potential of certain agents aimed at minimizing the risk of PRS. Two of these studies were excluded from this review for their enrolment of living donor transplants, but are important to mention for their evaluation of several vasoactive agents common in liver transplantation.…”