Incidence of vasoplegic syndrome during liver transplantation and patient outcomes

Abstract

Background

The incidence of vasoplegic syndrome during liver transplantation is unknown, and it is occasionally confused with postreperfusion syndrome, which is another similar form of hemodynamic instability. In these cases, monitoring patients with the Swan-Ganz catheter may be useful for differential diagnosis.

Aim

The main outcome was the incidence of vasoplegic syndrome or postreperfusion syndrome in the patients, and the prognosis of patients with vasoplegic syndrome was the secondary outcome.

Methods

This retrospective study included 246 consecutive orthotopic liver transplantation procedures performed in patients aged >18 years who were monitored using a Swan-Ganz catheter.

Vasoplegic syndrome was defined as mean arterial pressure <50 mmHg, pulmonary capillary wedge pressure ≤15 mmHg, central venous pressure <5 mmHg, cardiac index >2.5 L/min/m², systemic vascular resistance <800 dyn/s/cm^-5, and increased heart rate and mean pulmonary arterial pressure from the baseline (anhepatic phase). The estimated marginal means and their 95% confidence intervals were determined for the total sample.

Results

Of the 246 patients, only two (0.81%) developed vasoplegic syndrome after unclamping of the inferior vena cava. Another patient (0.40%) showed the hemodynamic features of vasoplegic syndrome but was diagnosed with septic shock due to positive blood culture. One patient with vasoplegic syndrome presented with postoperative renal failure and graft rejection, requiring another liver transplantation, and the other patient did not survive.

Conclusion

Most episodes of hemodynamic instability after liver graft reperfusion are due to postreperfusion syndrome, and the occurrence of vasoplegic syndrome is very rare and is associated with poor prognosis.