Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun;37(6):e15014.
doi: 10.1111/ctr.15014. Epub 2023 May 13.

Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients

Samuel DeMaria Jr  1 , Lyle Nolasco  1 , Divya Igwe  1 , Robert St Jules  1 , Yuki Bekki  2 , Natalie K Smith  1
Affiliations
Review

Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients

Samuel DeMaria Jr et al. Clin Transplant. 2023 Jun.

Abstract

Importance: This review explores proposed predictors, preventative measures, and treatment options for post-reperfusion syndrome (PRS) in liver transplantation and provides updated data for clinicians.

Objectives: The review aims to understand the status and progress made regarding PRS during orthotopic liver transplantation. Moreover, the predictors of PRS will be analyzed to highlight risk factors. Mediators of PRS and the modes of action of the currently available preventative and management agents that target particular PRS factors will be investigated.

Data sources: Data is drawn from secondary sources from databases of peer-reviewed journals. The bibliographies of select sources were also used to obtain additional data studies using the 'snowball' method.

Study selection: The initial data search provided 1394 studies analyzed using PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. After applying the eligibility criteria, 18 studies were fit for inclusion.

Results: The study identified that in addition to the severity of underlying medical conditions, other significant PRS predictors included patient age, sex, duration of cold ischemia, and the surgical technique. While the use of epinephrine and norepinephrine is well-established, further preventative measures commonly involve specifically targeting known mediators of the syndrome, such as antioxidants, vasodilators, free radical scavengers, and anticoagulants. Current management strategies involve supportive therapy. Machine Perfusion may ultimately decrease the risk of PRS.

Conclusion: PRS still holds unknowns, including the underlying pathophysiology, controllable factors, and ideal management practices. There is a need for further study, particularly prospective trials since liver transplantation is the gold standard for treating end-stage liver disease and the incidence of PRS remains high.

Keywords: liver transplantation; reperfusion liver cirrhosis.

PubMed Disclaimer

References

REFERENCES

    1. Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR. Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transplant Proc. 1987;19:54-55. https://pubmed.ncbi.nlm.nih.gov/3303534/
    1. Jeong SM. Postreperfusion syndrome during liver transplantation. Korean J Anesthesiol. 2015;68:527.
    1. Chui AKK, Shi L, Tanaka K, et al. Postreperfusion syndrome in orthotopic liver transplantation. Transplant Proc. 2000;32:2116-2117.
    1. Kodakat SK, Ginsburg R, Gopal PB, Rela M. A case of post-reperfusion syndrome following surgery for liver trauma. Br J Anaesth. 2006;96:31-35.
    1. Bukowicka B, Akar RA, Olszewska A, Smoter P, Krawczyk M. The occurrence of postreperfusion syndrome in orthotopic liver transplantation and its significance in terms of complications and short-term survival. Ann Transplant. 2011;16:26-30.

LinkOut - more resources