Reperfusão rápida e homogênea como fator de risco da síndrome pós-reperfusão hepática durante transplante ortotópico de fígado

Armas, Lucas Cordoví de; Paneque, Rosa Eugenia Jiménez; López, Boris Gala; Romero, E; Castillo, Ydriss Añuez; Menéndez, Marina Beatriz Vallongo

doi:10.1590/s0034-70942010000200007

Cited by 4 publications

(4 citation statements)

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“…Five patients had FFK values greater than 13 mmol/L, which may even trigger cardiac arrest after reperfusion. Further research will be needed to confirm whether pre-emptive interventions should be applied to prevent the development of severe PRS, such as advanced PVF with more flushing fluids, retrograde reperfusion [ 16 , 17 ], vasopressor pretreatment [ 32 , 33 ], or the speed-controlled reperfusion technique [ 20 , 21 ]. Third, the definition of severe PRS in this study inevitably included a state of vasoplegia or even VS, which is usually related to advanced liver disease and ischemia-reperfusion injury of the liver graft.…”

Section: Discussionmentioning

confidence: 99%

“…If severe hypotension and anuria persisted when the dose of NE increased to ≥0.5 μg/kg/min, infusion of vasopressin was started in response to a suspected diagnosis of vasoplegic syndrome (VS) [ 18 , 19 ]. If severe PRS occurred with significant arrhythmias due to hyperkalemia during the immediate postreperfusion period, intravenous boluses of calcium chloride and epinephrine together with speed control reperfusion technique [ 20 , 21 ]were used.…”

Section: Methodsmentioning

confidence: 99%

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Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

et al. 2017

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BackgroundsPredicting the occurrence of severe postreperfusion syndrome (PRS) is clinically challenging. We investigated whether the flushed fluid potassium concentration (FFK) was associated with severe PRS in deceased donor liver transplantation (DDLT).Material/MethodsForty adult DDLT recipients were enrolled in this retrospective study. Effluent solution samples were collected at the end of the portal vein flush, and the FFK was determined using a point-of-care blood gas analyzer. The risk factors associated with severe PRS and the clinical outcomes in 2 groups were compared.ResultsSevere PRS occurred in 22 out of 40 patients (55.0%). The FFK of the severe PRS group was significantly higher than that of the non-severe PRS group (median, 9.6 vs. 5.8, P<0.001). Other variables associated with severe PRS included the donor risk index (DRI), Child-Turcotte-Pugh score, donor type, donor warm ischemia time, and Model for End-stage Liver Disease score. The area under the receiver operator characteristic curve for the FFK was 0.982, and the best cut-off value of the FFK for predicting severe PRS was 6.75 mmol/L (100.0% sensitivity and 88.9% specificity). A significant positive correlation was observed between the FFK and DRI (R=0.714). Patients who experienced severe PRS had a higher early allograft dysfunction rate (63.6% vs. 22.2%, P=0.019) and a longer hospital stay (median, 33.0 vs. 24.0, P=0.034).ConclusionsBoth the severity of the recipient’s liver disease and the donor graft factors play an important role in the development of severe PRS in DDLT. An FFK of more than 6.75 mmol/L was associated with severe PRS after reperfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

et al. 2017

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“…Other ECDs include liver grafts with an older donor age, a higher donor serum sodium level, a higher degree of steatosis, and a prolonged CIT or warm ischemia time [ 20 , 22 , 23 ], while a frostbitten liver graft is an infrequent kind of ECD and may result in liver allograft primary nonfunction [ 25 ]. We currently encounter PRS and PRCA more frequently in LT using ECD liver grafts, despite the routine application of the PV flush and speed control reperfusion techniques [ 23 , 26 ]. Moreover, we occasionally encounter extremely high serum potassium levels after successful resuscitation of PRS and PRCA [ 16 – 18 ], and the release of intracellular potassium from the damaged hepatocytes of ECD liver grafts are the most likely cause ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Some institutes employ a speed-control reperfusion technique by manually controlling the reperfusion speed, which has been proposed as an effective method for the prevention of PRS and PRCA [ 23 , 26 ]. The results are in accordance with the changes in the serum potassium concentration after reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Expanded Criteria Donor-Related Hyperkalemia and Postreperfusion Cardiac Arrest During Liver Transplantation: A Case Report and Literature Review

et al. 2018

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BackgroundLiver transplantation (LT) using extended criteria donor (ECD) grafts is frequently associated with a high flush fluid potassium concentration (FFK) and acute hyperkalemia after reperfusion, which puts patients at greater risk of postreperfusion cardiac arrest (PRCA).Case ReportHerein, we present a case with an extremely high FFK that was successfully pretreated to avoid the risk of PRCA. A 3-year-old boy with biliary atresia underwent LT from a 623-g donation after brain death liver graft with localized frostbite on the right lobe surface. The FFK was 18.8 mmol/L after flushing with 1000 mL of 5% albumin. To prevent PRCA due to acute hyperkalemia, further portal vein (PV) flush, retrograde reperfusion via the inferior vena cava, and antegrade reperfusion via the PV were adopted to remove the excessive potassium ions. Ultimately, the liver graft was reperfused when the perfused blood potassium concentration was 7.5 mmol/L without subsequent development of PRCA during the immediate reperfusion period. Nevertheless, the patient still experienced vasoplegic syndrome during the late reperfusion period.ConclusionsOur case illustrates that the FFK measurement is helpful for identifying ECD-related hyperkalemia and for providing advance warning of PRCA. Future investigations are warranted to confirm the relationship between high FFK and PRCA and to observe the effectiveness of other interventions to prevent PRCA due to ECD-related hyperkalemia.

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Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation

et al. 2012

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Acute hypotension after reperfusion of the liver graft occurs frequently during liver transplantation. A randomized, prospective trial was performed to test the effects of epinephrine and phenylephrine pretreatments for attenuating postreperfusion syndrome (PRS). Ninety-three adult liver recipients were randomly allocated to receive an intravenous bolus of 10 lg of epinephrine, 100 lg of phenylephrine, or normal saline (the control group) at the time of graft reperfusion. The occurrence of PRS, the use of vasoactive drugs, and the postoperative courses were compared. The epinephrine and phenylephrine groups showed PRS less frequently (39% and 48%) than the control group (77%, P ¼ 0.006) as well as higher mean arterial pressures (MAPs) immediately after reperfusion (P < 0.05). An overshoot of MAP was observed in one-third of the pretreated patients with minimal heart rate changes. Only 2 patients in each pretreatment group showed an increase in MAP that was greater than 20% of the baseline value. The intraoperative epinephrine and dopamine requirements were significantly lower in both pretreatment groups. Perioperative laboratory data, postoperative stays, and in-hospital mortality rates were similar for the 3 groups. In conclusion, pretreatment with 10 lg of epinephrine or 100 lg of phenylephrine significantly reduces the occurrence of PRS and vasopressor requirements without immediate or delayed adverse effects in adult liver transplantation. Liver Transpl 18:1430-1439, 2012. V C 2012 AASLD.Received April 30, 2012; accepted July 7, 2012.Acute systemic hypotension frequently occurs immediately after reperfusion of the liver graft during orthotopic liver transplantation surgery. If a greater than 30% decrease in the mean arterial pressure (MAP) lasting more than 1 minute is observed within 5 minutes after reperfusion, postreperfusion syndrome (PRS) is diagnosed. 1 The reported incidence of PRS varies greatly (12%-81%) with the study design. 2-5 Typically, PRS is handled once it occurs instead of being proactively prevented because of its unpredictability and unclear underlying mechanism. However, because of the high incidence of PRS and its associated adverse effects, it seems reasonable to search for preventive measures. 2,4,[6][7][8] The piggyback technique and liver graft flushing are proven surgical prophylaxis methods for reducing PRS. 9-11 Another approach with varying degrees of success is pharmacological pretreatment, which is focused on blocking presumed causes of PRS such as ischemia/reperfusion cascades and their final products. 5,[12][13][14][15] However, previously tested drugs such as nafamostat mesilate, methylene blue, and aprotinin are neither familiar nor currently available to most anesthesiologists. Therefore, the anticipatory treatment of hypotension with vasoactive agents such as epinephrine and phenylephrine (rather than counteracting specific mediators of PRS) seems more practical. 15,16 Unfortunately, the only published study addressing the prophylactic use of adrenergic agonists to preve...

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Reperfusão rápida e homogênea como fator de risco da síndrome pós-reperfusão hepática durante transplante ortotópico de fígado

Cited by 4 publications

References 14 publications

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

Expanded Criteria Donor-Related Hyperkalemia and Postreperfusion Cardiac Arrest During Liver Transplantation: A Case Report and Literature Review

Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation

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