Risk factors for postreperfusion syndrome during living donor liver transplantation in paediatric patients with biliary atresia: a retrospective analysis

Abstract

BackgroundLiving donor liver transplantation (LT) is the main treatment for paediatric biliary atresia (BA) in Asia. During LT, a series of haemodynamic changes often occur during LT reperfusion, which is called postreperfusion syndrome (PRS), and PRS is related to a prolonged postoperative hospital stay, delayed recovery of graft function and increased mortality. To reduce adverse reactions after paediatric living donor LT (LDLT), our study’s objectives were to ascertain the incidence of PRS and analyse possible risk factors for PRS.MethodsWith the approval of the Ethics Committee of our hospital, the clinical data of 304 paediatric patients who underwent LDLT from January 2020 to December 2021 were analysed retrospectively. According to the presence or absence of PRS, the paediatric patients were divided into the non-PRS group and the PRS group. Independent risk factors of PRS were analysed using logistic regression analysis.ResultsPRS occurred in 132 recipients (43.4%). The peak values of AST (816 (507–1625) vs 678 (449–1107), p=0.016) and ALT (675 (415–1402) vs 545 (389–885), p=0.015) during the first 5 days after LDLT in paediatric patients with PRS were significantly higher than those in the non-PRS group. Meanwhile, the paediatric patients in the PRS group had longer intensive care unit stays and hospital stays, as well as lower 1-year survival rates. Graft cold ischaemic time (CIT) ≥90 min (OR (95% CI)=5.205 (3.094 to 8.754)) and a temperature <36°C immediately before reperfusion (OR (95% CI)=2.973 (1.669 to 5.295)) are independent risk factors for PRS.ConclusionsThe occurrence of hypothermia (<36.0℃) in children immediately before reperfusion and graft CIT≥90 min are independent risk factors for PRS. PRS was closely related to the postoperative adverse outcomes of paediatric patients.

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

“…In addition, Lauterio et al [ 7 ] recently showed that CIT >6 h and >10 h were associated with graft failure in a cohort of in-situ PSLT. Besides, CIT is related to PRS [ 12 ] and IRI which are known risk factors for graft loss [ 13 ]. HOPE has been shown to improve graft preservation by actively oxygenating the graft associated with shorter CIT [ 8 ], translating into decreased PRS [ 10 , 25 , 26 ], decreased EAD, ischemic type biliary complications and graft loss [ 11 ] in adult LT.…”

“…Additionally, meaningful statistical adjustments for recipient risk factors were not possible due to the small sample size. Nevertheless, early IRI events such as PRS [ 12 , 13 ] and IRI on reperfusion biopsy [ 30 ] have been shown to significantly impact long-term post-LT outcomes in larger cohorts, including LDLT [ 12 ] and serve as early surrogates of graft quality.…”

Paying attention to the value of thrombelastography and the impact of postreperfusion syndrome on outcomes of liver transplantation

“…In addition, the Gordon et al [ 1 ] study did not include all events that had an impact on prognosis in regression analysis, such as postreperfusion syndrome (PRS). PRS is defined as a significant decrease of over 30% in the mean arterial pressure compared with that at the end of the anhepatic phase, and this decrease has to last at least 1 minute and occur in the first 5 min after liver graft reperfusion[ 7 ]. Decreased body temperature in children before reperfusion and prolonged graft cold ischemia time are independent risk factors for PRS in pediatric liver transplantation[ 7 ].…”

“…PRS is defined as a significant decrease of over 30% in the mean arterial pressure compared with that at the end of the anhepatic phase, and this decrease has to last at least 1 minute and occur in the first 5 min after liver graft reperfusion[ 7 ]. Decreased body temperature in children before reperfusion and prolonged graft cold ischemia time are independent risk factors for PRS in pediatric liver transplantation[ 7 ]. Metabolic acidosis, hyperkalemia, hypocalcemia, and the release of many proinflammatory cytokines into the systemic circulation by the transplanted liver releasing after reperfusion are possible mechanisms for PRS[ 8 ].…”

“…Metabolic acidosis, hyperkalemia, hypocalcemia, and the release of many proinflammatory cytokines into the systemic circulation by the transplanted liver releasing after reperfusion are possible mechanisms for PRS[ 8 ]. PRS is one of the most common complications during liver transplantation and can lead to delayed recovery of graft function, prolonged hospitalization, and increased mortality and seriously affect quality of life in the postoperative period[ 7 , 9 ]. Therefore, we believe that PRS may have an important impact on the prognosis of children and should be included in regression analysis.…”