The reperfusion syndrome: Have we made any progress?

Ramsay, Michael A. E.

doi:10.1002/lt.21418

Cited by 34 publications

(38 citation statements)

References 23 publications

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“…The deleterious effects are not limited to the liver, but are seen in other organs, including the lungs and kidney[33]. IRI can trigger a systemic inflammatory response and subsequent multi-organ failure, the injury being characterised by intravascular oxidative stress and functional impairment of the mitochondria[34,35]. Peak serum AST is a surrogate marker of the severity of HIRI, and is closely correlated with the development of AKI, as confirmed in this study.…”

Section: Discussionsupporting

confidence: 61%

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Rahman

Davidson

Mallett

2017

WJH

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AIMTo investigate the additional clinical impact of hepatic ischaemia reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI) following liver transplantation.METHODSThis was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation (OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT (> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration (CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase (AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor (< 1000 IU/L), moderate (1000-5000 IU/L) or severe (> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications (AKI and HIRI) alone and then as a combined outcome.RESULTSOut of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustained moderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively (P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation (P < 0.001) and intensive care length of stay (P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication (P = 0.049).CONCLUSIONHIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.

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Section: Discussionsupporting

confidence: 61%

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Rahman

Davidson

Mallett

2017

WJH

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“…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%

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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“…The reflection of hemodynamic instability is the early onset of ARF after TOF 25,26 . This study found greater use of PRBC, FFP and platelets in the ARF group compared to the group NRF.…”

Section: Discussionmentioning

confidence: 99%

Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

Fonseca-Neto¹,

Miranda²,

Melo³

et al. 2011

ABCD, arq. bras. cir. dig.

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-Background -Acute kidney injury is one of the most common complications of orthotopic liver transplantation. The absence of universal criteria for definition of these conditions make comparisons difficult between studies. The conventional technique for transplantation is the total excision of the inferior vena cava during liver retro-native hepatectomy. Controversies about the effect of the conventional technique without venovenous bypass on renal function remain. Aim -To estimate the incidence and risk of acute kidney injury factors among recipients of orthotopic liver transplantation without conventional venovenous bypass. Methods -Was studied 375 patients undergoing orthotopic liver transplantation. Variables were analyzed in preoperative, intraoperative and postoperative complications in 153 patients undergoing orthotopic liver transplantation without conventional venovenous bypass. The criterion for acute kidney injury was serum creatinine ≥ 1.5 mg/dl or urinary debit <500 ml/24h within the first three days post-transplant. Univariate analysis and multivariate logistic regression were done. Results -All transplants were performed with grafts from deceased donors. Sixty patients (39.2%) had acute kidney injury. Age, body mass index, ChildTurcotte-Pugh, urea, hypertension, and preoperative serum creatinine were higher in the acute kidney injury group. During the intraoperative period, the group acute kidney injury had more reperfusion syndrome, transfusion of red blood cells, fresh frozen plasma and platelets. Postoperatively, the duration of mechanical ventilation and postoperative creatinine levels were also variable, with significant differences for the group of acute kidney injury. After logistic regression, the reperfusion syndrome, the class C of the Child-Turcotte-Pugh and postoperative serum creatinine showed differences. Conclusion -Acute kidney injury after orthotopic liver transplantation without conventional venovenous bypass is a common disorder, but with good prognosis. Reperfusion syndrome, serum creatinine postoperatively and Child C are factors associated with acute kidney injury after orthotopic liver transplantation without conventional venovenous bypass. ABCDDV/781RESUMO -Racional -Injúria renal aguda é uma das complicações mais comuns do transplante ortotópico de fígado. A ausência de critério universal para sua definição nestas condições dificulta as comparações entre os estudos. A técnica convencional para o transplante consiste na excisão total da veia cava inferior retro-hepática durante a hepatectomia nativa. Controvérsias sobre o efeito da técnica convencional sem desvio venovenoso na função renal continuam. Objetivo -Estimar a incidência e os fatores de risco de injúria renal aguda entre os receptores de transplante ortotópico de fígado convencional sem desvio venovenoso. Métodos -Foram avaliados 375 pacientes submetidos a transplante ortotópico de fígado. Foram analisadas as variáveis pré, intra e pós-operatórias em 153 pacientes submetidos a transplante ortotópico de fí...

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The reperfusion syndrome: Have we made any progress?

Cited by 34 publications

References 23 publications

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

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