Influence of surgical technique on postreperfusion syndrome during liver transplantation

Acosta, F; Rodríguez, M.A; Sansano, T; Contreras, Rafael; Reche, M; Roqués, V; Beltran, R; Robles, R; Bueno, F.S; Ramı́rez, Pablo; Parrilla, Pascual

doi:10.1016/s0041-1345(99)00390-5

Cited by 23 publications

(13 citation statements)

References 3 publications

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“…PRS has a reported incidence between 25% and 60% depending on the surgical technique, anesthetic management and preservation solutions (2,3). A recent report claimed that prevention or attenuation of PRS might be important, because PRS per se affected the outcome of the patient and the liver allograft (4).…”

Section: Introductionmentioning

confidence: 99%

“…Postreperfusion syndrome (PRS) was first described by Aggarwal and colleagues as follows: a > 30% decrease of mean arterial pressure (MAP) lasting over 1 min occurring within 5 min after reperfusion of the liver graft (1). PRS has a reported incidence between 25% and 60% depending on the surgical technique, anesthetic management and preservation solutions (2,3). A recent report claimed that prevention or attenuation of PRS might be important, because PRS per se affected the outcome of the patient and the liver allograft (4).…”

Section: Introductionmentioning

confidence: 99%

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Nafamostat Mesilate Attenuates Postreperfusion Syndrome during Liver Transplantation

Ryu

Jung

Lee

et al. 2011

American Journal of Transplantation

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Postreperfusion syndrome (PRS), an acute decrease in blood pressure after reperfusion of the liver graft, occurs frequently during liver transplantation surgery. We supposed that the activation of the kallikrein-kinin system leading to extensive systemic vasodilatation was a possible cause. The effect of pretreatment with nafamostat mesilate (NM), a broad spectrum serine protease inhibitor, on the occurrence of PRS was evaluated. Sixty-two adult liver recipients were randomized to receive an intravenous bolus of either 0.02 mg/kg of NM (NM group, n = 31) or an equal volume of normal saline (control group, n = 31) just before reperfusion of the liver graft. Occurrence of PRS and intraoperative use of vasoactive drugs were compared between the two groups. Postoperative recovery was also compared. PRS was significantly less frequent (48% vs. 81%, p = 0.016) requiring less vasopressors in the NM group compared to the control group. The NM group also showed faster recovery of the mean arterial pressure. Perioperative laboratory values were similar between the two groups. Pretreatment with 0.02 mg/kg of NM immediately before reperfusion decreases the frequency of PRS and vasopressor requirements during the reperfusion period in liver transplantation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nafamostat Mesilate Attenuates Postreperfusion Syndrome during Liver Transplantation

Ryu

Jung

Lee

et al. 2011

American Journal of Transplantation

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“…It would seem to be intuitively obvious that any vascular toxins that might be flushed out of the new liver graft would drain directly into the right heart and would be very likely to cause hemodynamic disturbances. Therefore, many different surgical and anesthetic techniques have been developed to minimize the severity of PRS 8–14. This has included flushing the preservation fluid and other vasoactive molecules from the graft prior to reperfusion, adjusting the reperfusion sequence, and also adding some specific pharmacological interventions.…”

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confidence: 99%

The reperfusion syndrome: Have we made any progress?

Ramsay

2008

Liver Transpl

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“…It was shown that the hypotension observed following reperfusion of the grafted liver during LTX occurs as frequently and with the same magnitude whether veno-venous bypass is used or not. The different influence of the standard and the piggyback technique on the PRS has been demonstrated [21]. The greatest decrease in MAP occurred in the standard group with veno-venous bypass, while changes in the piggyback group were smaller.…”

Section: Discussionmentioning

confidence: 96%

Lebertransplantation in Graz: Erfahrungen mit einer neuen Reperfusionsmethode

et al. 2004

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Lebertransplantation in Graz: Erfahrungen mit einer neuen ReperfusionsmethodeZusammenfassung. Grundlagen: Die unzulängliche initiale Organfunktion nach der Reperfusion bleibt ein wesentliches Problem der Lebertransplantation. In unserem Zentrum wurde eine neue Methode der Reperfusion entwickelt. In einer retrospektiven Studie wurden die Daten der letzten 6 Jahre evaluiert.Methodik: Neunundsiebzig Lebertransplantationen wurden in Piggyback-Technik und mit retrograder Reperfusion über die Vena cava und anschließender antegrader Reperfusion über die Vena portae durchgeführt.Ergebnisse: 68 der 74 Patienten (91,9 %) waren am 8. postoperativen Tag am Leben. Die initiale Graftfunktion war gut. Am 1. Tag nach der Transplantation betrug die mittlere Aspartataminotransferase 526 U/L, am Tag 8 post operationem 48 U/L. Außer bei 3 Patienten mit ArteriaHepatica-Thrombose traten kein primäres Graftversagen und keine schlechte primäre Graftfunktion auf. Ein Postreperfusionssyndrom wurde bei 3,6 % beobachtet.Schlussfolgerungen: Die retrospektive Studie zeigte, dass unsere Reperfusionsmethode realisierbar ist. Eine gute primäre Graftfunktion und niedrige postoperative Leberenzymwerte konnten beobachtet werden. Hämody-namische Probleme waren selten.Schlüsselwörter: Lebertransplantation, Reperfusion, primäres Graftversagen, Postreperfusionssyndrom.Summary. Background: Poor initial graft function secondary to reperfusion remains a major problem in liver transplantation. A new technique of reperfusion was introduced in our center and evaluated in a retrospective study covering the last 6 years.Methods: Seventy-nine liver transplantations were performed by piggyback technique with retrograde reperfusion via the caval vein and antegrade reperfusion via the portal vein.Results: Sixty-eight out of 74 patients (91.9%) were alive and well at day 8 after LTX. On day 1 after liver transplantation, mean aspartate aminotransferase was 526 U/L and on day 8 it was 48 U/L. Except in the 3 patients presenting with hepatic artery thrombosis, primary nonfunction or poor early graft function did not occur. A postreperfusion syndrome was observed in 3.6%Conclusions: After retrograde reperfusion, low postoperative liver enzyme values and good initial liver function can be observed. Furthermore, hemodynamic disturbances were uncommon.

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Influence of surgical technique on postreperfusion syndrome during liver transplantation

Cited by 23 publications

References 3 publications

Nafamostat Mesilate Attenuates Postreperfusion Syndrome during Liver Transplantation

Nafamostat Mesilate Attenuates Postreperfusion Syndrome during Liver Transplantation

The reperfusion syndrome: Have we made any progress?

Lebertransplantation in Graz: Erfahrungen mit einer neuen Reperfusionsmethode

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