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POSTREPERFUSION SYNDROME IN PATIENTS RECEIVING VASOACTIVE DRUGS DURING LIVER GRAFT REPERFUSION

SUSANA GONZÁLEZ SUÁREZ, HELENA A SERRANO, IVETTE Z CHOCRON, PİLAR TORMOS, ESTHER CANO, PATRİCİA GALÁN, MİRİAM DE NADAL, SİLVİA MATARÍN, MARÍA CABEZA, ANA B RODRÍGUEZ TESOURO

Experimental and Clinical Transplantation - 2024;22(1):43-51

Department of Surgery, Universitat Autònoma de Barcelona, Unitat Docent Vall d´Hebron, Barcelona, Spain

 

Objectives: The most widely used definition of postreperfusion syndrome in liver transplant is a 30% decrease in mean arterial pressure during the first 5 minutes after vascular unclamping. With these criteria, increased postoperative morbidity has been reported. Vasoactive drugs could prevent this syndrome. The main objective of our study was to determine the incidence and complications associated with postreperfusion syndrome in patients who received vasoactive support. Materials and Methods: We studied 246 patients who received norepinephrine infusions to maintain mean arterial pressure ≥60 mm Hg and who were monitored with a Swan-Ganz catheter. Patients received a bolus of adrenaline after vascular unclamping in cases of insufficient response to norepinephrine. Results: Among the study patients, 57 (23.17%) developed postreperfusion syndrome. Patients who developed postreperfusion syndrome did not present with more postoperative complications in terms of renal dysfunction (P = .69), repeat surgery (P = .15), graft rejection (P = .69), transplant replacement surgery (P = .76), hospital stay (P = .70), or survival (P = .17) compared with patients without postreperfusion syndrome. Conclusions: In patients who underwent orthotopic liver transplant, in whom vasoactive drugs were administered, a diagnosis of self-limited postreperfusion syndrome during the first 5 minutes after unclamping may not be associated with postoperative complications. The administration of vasoconstrictors may have a preventive effect on the postoperative complications associated with postreperfusion syndrome or they may mask the real incidence of postreperfusion syndrome. A broader definition of postreperfusion syndrome should be accepted.