Postreperfusion syndrome in orthotopic liver transplantation

Chui, A.K.K; Shi, Liwei; Tanaka, Kōichi; Rao, Archana; Wang, L.S; Bookallil, M.; Mayr, Max; Chiu, Edmond; Verran, Deborah; Mears, D. C.; Sheil, A. G. R.

doi:10.1016/s0041-1345(00)01595-5

Cited by 48 publications

(45 citation statements)

References 5 publications

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“…Among potential recipient variables, no factor appeared to be a predictor of PRS in the current study. This is in accordance with most of the previously reported results 3, 7, 9, 10. Consequently, PRS appears to be unpredictable on the basis of only recipient factors.…”

Section: Discussionsupporting

confidence: 93%

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Postreperfusion syndrome during liver transplantation for cirrhosis: Outcome and predictors

Paugam–Burtz

Kavafyan²,

Merckx³

et al. 2009

Liver Transpl

228

213

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During orthotopic liver transplantation (OLT), a marked decrease in blood pressure following unclamping of the portal vein and liver reperfusion is frequently observed and is termed postreperfusion syndrome (PRS). The predictive factors and clinical consequences of PRS are not fully understood. The goal of this study was to identify predictors of PRS and morbidity/mortality associated with its occurrence during OLT in patients with cirrhosis. During a 3-year period, all consecutive OLT procedures performed in patients with cirrhosis were studied. Exclusion criteria were OLT for acute liver failure, early retransplantation, combined liver/kidney transplantation, and living-donor related transplantation. PRS was defined as a decrease in the mean arterial pressure of more than 30% of the value observed in the anhepatic stage, for more than 1 minute during the first 5 minutes after reperfusion of the graft. Transplantation was performed with preservation of the inferior vena cava with or without temporary portocaval shunt. Associations between PRS and donor and recipient demographic data, recipient operative and postoperative outcomes were tested with bivariate statistics. Independent predictors of PRS were determined in multivariable logistic regression analysis. Of the 75 patients included in the study, 20 patients (25%) developed PRS. In a multivariable analysis, absence of a portocaval shunt [odds ratio (95% confidence interval) ϭ 4.42 (1.18-17.6)] and duration of cold ischemia [odds ratio (95% confidence interval) ϭ 1.34 (1.07-1.72)] were independent predictors of PRS. Patients who experienced PRS displayed more postoperative renal failure and lower early (Ͻ15 days after OLT) survival (80% versus 96%; P ϭ 0.04). In conclusion, the absence of portocaval shunt and the duration of cold ischemia were independent predictors of intraoperative PRS. PRS was associated with significant adverse postoperative outcome. These results provide realistic clinical targets to improve patient outcome after OLT for cirrhosis. Liver Transpl 15:522-529, 2009.

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Section: Discussionsupporting

confidence: 93%

“…The most important difference seems to be within the definition of PRS. Variation of the mean arterial blood pressure has been used as a relative decrease from the level of pressure during the anhepatic stage or as an absolute value under 60 mm Hg, for example 9, 10. These criteria are easy to determine but are probably restrictive.…”

Section: Discussionmentioning

confidence: 99%

Postreperfusion syndrome during liver transplantation for cirrhosis: Outcome and predictors

Paugam–Burtz

Kavafyan²,

Merckx³

et al. 2009

Liver Transpl

228

213

View full text Add to dashboard Cite

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“…PRS is a transient and occasionally profound cardiovascular collapse that occurs after the release of the portal clamp and was initially defined as a 30% decrease in mean arterial pressure (MAP) within the first 5 minutes after reperfusion. [15] The incidence of PRS in our study was 56%. This decrease in the MAP was found to be associated with a decrease in the SVR, not due to a decrease in myocardial contractility.…”

Section: Discussionmentioning

confidence: 53%

Use of transesophageal Doppler as a sole cardiac output monitor for reperfusion hemodynamic changes during living donor liver transplantation

Hussien

Refaat

Fayed

et al. 2011

Saudi Journal of Anaesthesia

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Aims:To report the use of transesophageal Doppler (TED), a minimally invasive cardiac output (COP) monitor, before, during and after reperfusion and study its effect on anesthetic management during living donor liver transplantation (LDLT).Setting and Design:A prospective observational study.Methods:A total of 25 consecutive recipients with a MELD score between 15 and 20 were enrolled. Data were recorded at baseline (TB); anhepatic phase (TA); and post-reperfusion — 1, 5, 10 and 30 minutes. Fluid therapy was guided by corrected flow time (FTc) of the TED. Packed red blood cells (RBCs) were only given when hematocrit was less than 25%. Rotational thromboelastometry (ROTEM) and standard laboratory tests were used to guide component blood products requirements.Results:Post-reperfusion, the COP, Cardiac Index (CI) and stroke volume (SV) increased significantly at all points of measurements; this was associated with a significant decrease in systemic vascular resistance (SVR) (P ;< .05). Immediately post-reperfusion, for 5 minutes, mean arterial blood pressure (ABP) dropped significantly (P < .05), and 14 out of the 25 patients required boluses of epinephrine (10 μg) to restore the mean ABP; 3 of the 14 patients required norepinephrine infusion till the end of surgery. Central venous pressure (CVP) and urine output (UOP) at all measures were maintained adequately with FTc-guided fluid replacement. Eight out of the 25 patients required no blood transfusion, and 4 of the 8 patients required no catecholamine support.Conclusion:TED as a sole monitor for COP was able to present significant and reliable changes in the cardiovascular status of the recipients during reperfusion, which could help to guide fluid- and drug-supportive therapy in this population of patients. This preliminary study needs to be applied on a larger scale.

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“…Several possible factors have been indicated, such as the release of vasoactive substances from the liver graft or the recipient gut-potassium, acids, prostanoids, bradykinin, interleukins-along with hypovolemia, hypothermia, or small air or thrombotic emboli (Chui et al, 2000;Ricciardi et al, 2002). Several possible factors have been indicated, such as the release of vasoactive substances from the liver graft or the recipient gut-potassium, acids, prostanoids, bradykinin, interleukins-along with hypovolemia, hypothermia, or small air or thrombotic emboli (Chui et al, 2000;Ricciardi et al, 2002).…”

Section: Special Situations Acute Liver Failurementioning

confidence: 99%