The occurrence of postreperfusion syndrome in orthotopic liver transplantation and its significance in terms of complications and short-term survival

Bukowicka, Barbara; Akar, Rami Abi; Olszewska, Anna; Smoter, Piotr; Krawczyk, Marek

doi:10.12659/aot.881861

Cited by 86 publications

(89 citation statements)

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“…In addition, since prothrombin time extended over 3.0 INR, the patient required continuous transfusion with fresh frozen plasma. Although we cannot assure that the most important cause of primary non-functioning of hepatic graft after multivisceral transplantation in our case was due to the prolonged severe PRS or poor initial graft dysfunction from the cadaveric donor, it is possible to consider that poor initial hepatic graft dysfunction and subsequent severely prolonged PRS may further aggravate hepatic graft dysfunction, because the significant associations between low MAP and negative surgical outcomes, including initial poor graft function, primary graft non-function, or death has been reported [4,15]. …”

Section: Discussionmentioning

confidence: 99%

Prolonged post-reperfusion syndrome during multivisceral organ transplantation in a pediatric patient: a case report

Park

Hwang

et al. 2014

Korean J Anesthesiol

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Multivisceral organ transplantation involves the transplantation of three or more abdominal organs, including small bowel, duodenum, stomach, liver, pancreas, colon, and so on. The large amounts of cold and acidic loading into systemic circulation from the graft during multivisceral organ transplantation may result in severe post-reperfusion syndrome (PRS). We describe here a 6-year-old pediatric patient with chronic intestinal pseudo-obstruction who experienced prolonged PRS and severe metabolic acidosis during seven abdominal organ transplantation including the liver, spleen, stomach, duodenum, small bowel, colon and pancreas. The hypotensive period lasted approximately 10 minutes after graft reperfusion and was accompanied by severe metabolic acidosis and hypothermia. Since PRS can be easily associated with adverse outcomes, such as poor early graft function and primary non-function, not only meticulous surveillance for aggravating factors for PRS but also their immediate correction were necessary in managing a pediatric patient undergoing multivisceral organ transplantation.

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Section: Discussionmentioning

confidence: 99%

Prolonged post-reperfusion syndrome during multivisceral organ transplantation in a pediatric patient: a case report

Park

Hwang

et al. 2014

Korean J Anesthesiol

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“…Specifically, the extended clamping and unclamping of the inferior vena cava and the portal vein during the surgery pose a risk to the patients. In particular, reperfusion of the transplanted liver graft through the portal vein may induce severe cardiovascular collapse, and this severe hemodynamic change may adversely affect perioperative morbidity and mortality [2][3][4]. Many attempts have been made to determine the causes of PRS during liver transplantation to be able to develop strategies to minimize the risk of developing PRS [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…PRS is considered one of the most critical events that can occur during liver transplantation, because it may be associated with longer postoperative mechanical ventilation assistance and intensive care unit stay, as well as higher risk of postoperative acute renal failure and 1-year mortality [2][3][4]. However, the physiological mechanisms underlying PRS are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

et al. 2013

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Objective Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS. Methods Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence. Results Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P \ 0.001) and the ratio of low frequency power to high frequency power (LF/ HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P \ 0.001).Interpretation Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.

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“…12 Aggarwal et al 13 first defined PRS as a drop in the MAP by over 30% from baseline, lasting at least 1 minute and occurring within the first 5 minutes following reperfusion, and may be associated with asystole or malignant arrhythmias and fibrinolysis. The incidence of PRS has been quoted to be between 12% and 77% 14,15 and despite numerous studies, few universal risk factors or effective predictors have been elucidated. However, graft cold ischemic time (CIT) of 10 hours or more has been frequently implicated.…”

Section: Discussionmentioning

confidence: 99%

“…However, graft cold ischemic time (CIT) of 10 hours or more has been frequently implicated. 5,14,16 Additionally, PRS is thought to be related to the hyperkalemic, hypothermic, acidic, inflammatory mediator-rich reperfusate from a liver graft which has suffered an ischemia-reperfusion injury. 7 Activation of the complement system and proinflammatory cytokines including interleukin-6 and tumor necrosis factor-α as well as oxygen free radicals, have also been implicated as causing myocardial depression and vasodilation.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation

Kim

DeMaría

Cohen

et al. 2016

Semin Cardiothorac Vasc Anesth

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We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation. Cardiothoracic surgery was consulted for potential use of extracorporeal membrane oxygenation, however, the myocardial function improved and the surgery was completed without further intervention. On postoperative day 6, the patient was extubated without neurologic or cardiac impairment. The patient continues to do well 2 years posttransplant, able to perform independent daily activities of living and his previous job. This case underscores the potential for positive outcomes with profoundly prolonged, effective advanced cardiovascular life support in patients who experience postreperfusion syndrome.

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The occurrence of postreperfusion syndrome in orthotopic liver transplantation and its significance in terms of complications and short-term survival

Cited by 86 publications

References 0 publications

Prolonged post-reperfusion syndrome during multivisceral organ transplantation in a pediatric patient: a case report

Prolonged post-reperfusion syndrome during multivisceral organ transplantation in a pediatric patient: a case report

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation

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