Exploring the Occurrence and Determinants of Post-Reperfusion Syndrome in Living Donor Liver Transplantation

Abstract

Background

During reperfusion of the allograft liver, significant hemodynamic instability is observed in the form of post-reperfusion syndrome (PRS), which results in extreme hypotension, bradycardia, or arrhythmias. The documented incidence and risk factors of PRS are mainly based on cadaveric liver transplantation.

Objectives

To estimate the incidence and evaluate the factors associated with PRS in living donor liver transplantation.

Method

We prospectively observed 70 adult patients with chronic liver disease who underwent a living donor liver transplant over a period from August 2020 to March 2022. The patients were divided into two groups based on the development of post reperfusion syndrome as PRS and non-PRS group.

Results

Post-reperfusion syndrome occurred in 26 of 70 recipients (37.1%). The patient who developed PRS had a significantly higher mean MELD score (p = 0.027), lower preoperative fibrinogen levels (p = 0.015), and prolonged graft cold ischemia time (p = 0.045). These patients also had significantly increased blood loss (p = 0.031) and received higher amounts of blood products intraoperatively. Among the postoperative outcomes, the median duration of mechanical ventilation (p = 0.009), time taken to taper vasopressors (p = 0.001), and peak bilirubin level (p = 0.002) during the first 7 days after liver transplantation were significantly higher in the PRS group.

Conclusion

The patients who developed PRS had more severe liver disease with increased blood loss and blood product transfusions. Among the postoperative variables, duration of mechanical ventilation, vasopressor requirement, and peak bilirubin levels were significantly higher in those who developed PRS.