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. 2018 May 18:23:334-344.
doi: 10.12659/AOT.909050.

Diagnosis, Incidence, Predictors and Management of Postreperfusion Syndrome in Pediatric Deceased Donor Liver Transplantation: A Single-Center Study

Liang Zhang  1 , Ming Tian  1 , Fushan Xue  1 , Zhijun Zhu  2   3
Affiliations

Diagnosis, Incidence, Predictors and Management of Postreperfusion Syndrome in Pediatric Deceased Donor Liver Transplantation: A Single-Center Study

Liang Zhang et al. Ann Transplant. .

Abstract

BACKGROUND Postreperfusion syndrome (PRS) is a dreadful and well-documented complication in adult liver transplantation (LT). However, information regarding PRS in pediatric LT is still scarce. We aimed to identify the incidence, risk factors and associated outcomes of pediatric LT in a single-center study. MATERIAL AND METHODS The medical records of 75 consecutive pediatric patients who underwent deceased donor liver transplantation (DDLT) from July 2015 to October 2017 were retrospectively reviewed. PRS was determined according to the Peking criteria when significant arrhythmia or refractory hypotension occurred following revascularization of the liver graft. Patients were divided into PRS and non-PRS groups. Preoperative, intraoperative, and postoperative data were collected and compared between the 2 groups. Independent risk factors for PRS were analyzed using binary logistic regression analysis. RESULTS PRS occurred in 26 patients (34.7%). Univariate analysis showed that the graft-to-recipient weight ratio (P=0.023), donor warm ischemia time (P<0.001), and the use of an expanded criteria donor (ECD) liver graft (P<0.001) were significant predictors of PRS. Binary logistic regression showed that the use of an ECD liver graft (odds ratio [OR]: 18.668; 95% confidence interval [95% CI]: 4.866-71.622) and lower hematocrit (HCT) level before reperfusion (OR: 0.878; 95% CI: 0.782-0.985) were independent predictors of PRS. PRS was significantly associated with early allograft dysfunction (73.1% vs. 18.4%, P<0.001), primary nonfunction (11.5% vs. 0.0%, P=0.039), and a prolonged hospital stay (median: 30.5 vs. 21.0, P=0.007). CONCLUSIONS The use of an ECD liver graft and lower HCT level before reperfusion were independent risk factors for PRS in pediatric DDLT. Intraoperative PRS occurrence seems to be associated with poor liver allograft function and worsened patient postoperative outcomes.

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Conflict of interest statement

Conflicts of interest

None.

Figures

Figure 1
Figure 1
Suggested prevention, diagnosis, and treatment algorithm for PRS in pediatric DDLT: the Beijing Friendship Hospital (BFH) experience. AB – actual bicarbonate; BE – base excess; Ca – ionized calcium concentration; CPB – cardiopulmonary bypass; CPR – cardiopulmonary resuscitation; CVP – central venous pressure; DDLT – deceased donor liver transplantation; ECMO – extracorporeal membrane oxygenation; HCT – hematocrit; HR – heart rate; ICU – intensive care unit; K – serum potassium concentration; NE – norepinephrine; PRN – as necessary; PRS – postreperfusion syndrome; PV – portal vein; SAP – systolic arterial pressure; T – body temperature; VS – vasoplegic syndrome.
Figure 2
Figure 2
Types of manifestations of PRS in the 26 pediatric DDLT patients. DDLT – deceased donor liver transplantation; NE – norepinephrine; PRCA – postreperfusion cardiac arrest; PRS – postreperfusion syndrome; VS – vasoplegic syndrome.
Figure 3
Figure 3
Hemodynamic changes during the reperfusion period in pediatric DDLT. CVP – central venous pressure; DDLT – deceased donor liver transplantation; HR – heart rate; PRS – postreperfusion syndrome; R – reperfusion; SAP – systolic arterial pressure. * P<0.05.
Figure 4
Figure 4
Forms of expanded criteria donor liver grafts in this study. DCD – donation after cardiac death.
See this image and copyright information in PMC

References

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