Korean J Anesthesiol.  2015 Dec;68(6):527-539. 10.4097/kjae.2015.68.6.527.

Postreperfusion syndrome during liver transplantation

• Jeong SM

• KMID: 2237302
• DOI: http://doi.org/10.4097/kjae.2015.68.6.527

Abstract

As surgical and graft preservation techniques have improved and immunosuppressive drugs have advanced, liver transplantation (LT) is now considered the gold standard for treating patients with end-stage liver disease worldwide. However, despite the improved survival following LT, severe hemodynamic disturbances during LT remain a serious issue for the anesthesiologist. The greatest hemodynamic disturbance is postreperfusion syndrome (PRS), which occurs at reperfusion of the donated liver after unclamping of the portal vein. PRS is characterized by marked decreases in mean arterial pressure and systemic vascular resistance, and moderate increases in pulmonary arterial pressure and central venous pressure. The underlying pathophysiological mechanisms of PRS are complex. Moreover, risk factors associated with PRS are not fully understood. Rapid and appropriate treatment with vasopressors, volume replacement, or venesection must be provided depending on the cause of the hemodynamic disturbance when hemodynamic instability becomes profound after reperfusion. The negative effects of PRS on postoperative early morbidity and mortality are clear, but the effect of PRS on postoperative long-term mortality remains a matter of debate.

Keyword

Hemodynamic disturbance; Liver transplantation; Reperfusion

MeSH Terms

Arterial Pressure
Central Venous Pressure
Hemodynamics
Humans
Liver Diseases
Liver Transplantation*
Liver*
Mortality
Phlebotomy
Portal Vein
Reperfusion
Risk Factors
Transplants
Vascular Resistance