Hyperdynamic circulation in acute liver failure: reperfusion syndrome and outcome following liver transplantation.
OBJECTIVE
Liver transplantation (OLT) is a valid therapeutic option for patients with fulminant hepatic failure (FHF). The most critical phase during OLT is considered to be graft reperfusion, where in large changes in patient homeostasis occur. The aims of the present study were to evaluate the hemodynamic and cardiac changes among a large series of patients with FHF, to determine independent clinical predictors of the occurrence of postreperfusion syndrome (PSR) and its relationship to clinical and hemodynamic parameters and transplant outcomes.


METHODS
Systemic hemodynamic and cardiac functions were evaluated by Swan-Ganz catheterization in 58 patients before OLT. The patients were divided into two subgroups on the basis of PSR, which was defined as a mean arterial blood pressure 30% lower than the immediate previous value lasting for at least 1 minute within 5 minutes after unclamping.


RESULTS
PSR occurred in 24 patients (41%). Significant differences upon bivariate analysis was observed for the Model for End-stage Liver Disease score, which was significantly higher among patients with PSR, namely 32 (range = 18-43) versus 23 (range = 12-32) (P = .001). Higher serum creatinine values were significantly different among patients with PSR: 1.4 (range = 1.2-2.2) versus 2.1 (range = 2.5-3.2) mg/dL (P < .01).


CONCLUSIONS
Systemic hemodynamic alterations of FHF progressively worsen with increasing severity of liver disease. PSR developed in approximately 40% of patients; its prevalence was significantly related to the severity of the disease. Finally, patients with renal failure showed greater risk to develop an PSR during OLT.
Division of Anestesiology, University of Bologna, Bologna, Italy. sinianest@libero.it
A
A
Siniscalchi
A
A
Dante
S
S
Spedicato
L
L
Riganello
A
A
Zanoni
M
M
Cimatti
E
E
Pierucci
E
E
Bernardi
Z
Z
Miklosova
C
C
Moretti
S
S
Faenza
D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013577:Syndrome
D003404:Creatinine; D001663:Bilirubin