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2015 ; 68
(6
): 527-39
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Postreperfusion syndrome during liver transplantation
#MMPMID26634075
Jeong SM
Korean J Anesthesiol
2015[Dec]; 68
(6
): 527-39
PMID26634075
show ga
As surgical and graft preservation techniques have improved and immunosuppressive
drugs have advanced, liver transplantation (LT) is now considered the gold
standard for treating patients with end-stage liver disease worldwide. However,
despite the improved survival following LT, severe hemodynamic disturbances
during LT remain a serious issue for the anesthesiologist. The greatest
hemodynamic disturbance is postreperfusion syndrome (PRS), which occurs at
reperfusion of the donated liver after unclamping of the portal vein. PRS is
characterized by marked decreases in mean arterial pressure and systemic vascular
resistance, and moderate increases in pulmonary arterial pressure and central
venous pressure. The underlying pathophysiological mechanisms of PRS are complex.
Moreover, risk factors associated with PRS are not fully understood. Rapid and
appropriate treatment with vasopressors, volume replacement, or venesection must
be provided depending on the cause of the hemodynamic disturbance when
hemodynamic instability becomes profound after reperfusion. The negative effects
of PRS on postoperative early morbidity and mortality are clear, but the effect
of PRS on postoperative long-term mortality remains a matter of debate.