title: The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation.
abstract: The greatest part of liver allograft injury occurs during reperfusion, not during the cold ischemia phase. The aim of this study, therefore, was to investigate how the severity of postreperfusion syndrome (PRS) influences short-term outcome for the patient and for the liver allograft. Over a 2-year period, 338 consecutive patients who presented for orthotopic liver transplantation (OLT) were included in this retrospective study. They were divided into 2 groups according to the severity of the PRS they experienced. The first group comprised 152 patients with mild or no PRS; the second group comprised 186 patients with significant PRS. Perioperative hemodynamic parameters, coagulation profiles, blood product requirements, incidence of infection, incidence of rejection and outcome data for both groups were collected and analyzed. There was no demographic difference between the groups except for age; group 2 had older patients than group 1 (54.94 +/- 9.07 versus 51.52 +/- 9.91, P = 0.001). Compared to group 1, group 2 patients required more red blood cell transfusions (11.31 +/- 10.90 versus 8.08 +/- 7.89 units, P = 0.002), more fresh frozen plasma transfusions (10.25 +/- 10.96 versus 7.03 +/- 7.64 units, P = 0.002), more cryoprecipitate (1.88 +/- 4.72 units versus 0.61 +/- 1.80 units, P = 0.001), and were more likely to suffer from fibrinolysis (52.7% versus 41.4%, P = 0.041). Interestingly, group 2 had a shorter average warm ischemia time than group 1 (33.19 +/- 8.55 versus 36.21 +/- 11.83 minutes, P = 0.01). Group 2 also required longer, on average, mechanical ventilation (14.95 +/- 29.79 versus 8.55 +/- 17.79 days, P = 0.015), remained in the intensive care unit longer (17.65 +/- 31.00 versus 11.49 +/- 18.67 days, P = 0.025), and had a longer hospital stay (27.29 +/- 32.35 versus 20.85 +/- 21.08 days, P = 0.029). Group 2 was more likely to require retransplantation (8.6% versus 3.3%, P = 0.044). In conclusion, the severity of PRS during OLT appears to be related to the outcome of patient and liver allograft.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. hilmiia@anes.upmc.edu
authors.forename: Ibtesam
authors.initials: I
authors.lastname: Hilmi
authors.forename: Charles N
authors.initials: CN
authors.lastname: Horton
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Planinsic
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sakai
authors.forename: Ramona
authors.initials: R
authors.lastname: Nicolau-Raducu
authors.forename: Daniela
authors.initials: D
authors.lastname: Damian
authors.forename: Silivu
authors.initials: S
authors.lastname: Gligor
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015424:Reperfusion; D015427:Reperfusion Injury / Q000453:epidemiology*; D012189:Retrospective Studies; D013577:Syndrome; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome