Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Abstract

Objective Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS. Methods Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence. Results Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P \ 0.001) and the ratio of low frequency power to high frequency power (LF/ HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P \ 0.001).Interpretation Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.

Acute kidney injury and post-reperfusion syndrome in liver transplantation

“…The loss of integrity of the vasoconstrictive response during graft reperfusion is also believed to be, at least partially, responsible for the development PRS[85,86]. …”

“…Garutti Martinez et al[85] reported a lower increase in vascular muscle tone reflected by an increased systemic vascular resistance index in patients experiencing PRS, suggesting a reduced vascular adaptability in these patients. A significant reduction in sympathetic tone has also been reported in patients who developed PRS[86]. Although altered cardiovascular autonomic control may not clarify the reason for the occurrence of graft reperfusion-related hypotension during LT, the assessment of autonomic indices may be helpful in predicting PRS occurrence and may help anaesthesiologist management in preventive treatment with vasoconstrictors before any substantial decrease in MAP in the first minutes after reperfusion.…”

Signaling through hepatocyte vasopressin receptor 1 protects mouse liver from ischemia-reperfusion injury

“…Its release to peripheral blood can be triggered by hypovolemia, hypotension, increase osmolarity, increased angiotensin II, etc [16]. Although it remains elusive as to how IR triggers the release of AVP, we believe this is most likely due to the transient hypotension caused by decreased venous blood return to the heart after the total portal pedicle occlusion, as well as reperfusion-induced hypotension [17]. Besides, other mechanisms may operate in this setting.…”

Atrioventricular conduction disturbances immediately after hepatic graft reperfusion and their outcomes in patients undergoing liver transplantation

“…As for the graft preservative solution, histidine tryptophan ketoglutarate solutions were used in all patients. The anesthetic management, patient care, and hemodynamic data recruitment for LT surgery were performed according to the standard institutional protocol of Asan Medical Center, which was previously described in detail . Briefly, anesthesia was induced with thiopental sodium, fentanyl, and vecuronium.…”

“…The anesthetic management, patient care, and hemodynamic data recruitment for LT surgery were performed according to the standard institutional protocol of Asan Medical Center, which was previously described in detail. (9)(10)(11)(12)(13) Briefly, anesthesia was induced with thiopental sodium, fentanyl, and vecuronium. After endotracheal intubation, anesthesia was maintained with isoflurane or sevoflurane in a 50% air/oxygen mixture and continuous infusion of fentanyl and vecuronium.…”