Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study

Abstract

BackgroundThe discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD).MethodsIn this single center retrospective analysis of 122 cadaveric LT recipients, we investigated predictors of postreperfusion syndrome (PRS) including transplant liver quality categorized by both histological assessment of steatosis and subjective visual assessment by the transplanting surgeon using multivariable regression analysis. Furthermore, we describe the relevance of PRS during the intraoperative and postoperative course of LT recipients.Results53.3% (n = 65) of the patients suffered from PRS. Risk factors for PRS were visually assessed organ quality of the liver grafts (acceptable: OR 12.2 [95% CI 2.43–61.59], P = 0.002; poor: OR 13.4 [95% CI 1.48–121.1], P = 0.02) as well as intraoperative norepinephrine dosage before reperfusion (OR 2.2 [95% CI 1.26–3.86] per 0.1 μg kg− 1 min− 1, P = 0.01). In contrast, histological assessment of the graft was not associated with PRS. LT recipients suffering from PRS were hemodynamically more instable after reperfusion compared to recipients not suffering from PRS. They had lower mean arterial pressures until the end of surgery (P < 0.001), received more epinephrine and norepinephrine before reperfusion (P = 0.02 and P < 0.001, respectively) as well as higher rates of continuous infusion of norepinephrine (P < 0.001) and vasopressin (P = 0.02) after reperfusion. Postoperative peak AST was significantly higher (P = 0.001) in LT recipients with PRS. LT recipients with intraoperative PRS had more postoperative adverse cardiac events (P = 0.05) and suffered more often from postoperative delirium (P = 0.04).ConclusionsPatients receiving ECD liver grafts are especially prone to PRS. Anesthesiologists should keep these newly described risk factors in mind when preparing for reperfusion in patients receiving high-risk organs.

Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

“…Similar to previous studies, higher rates of PRS, as seen in our microsteatosis group, resulted in a more complicated postoperative course. (23) Patients in the microsteatosis group had higher rates of EAD (38.2%) than patients in the no steatosis group (23.0%). Four previous studies reported the rates of delayed graft function (DGF)/ EAD in patients receiving a liver graft with microsteatosis compared with liver grafts with little or no steatosis.…”

“…PRS was seen in a larger proportion of patients receiving donor livers with microsteatosis ≥30% (33.1%) than in the matched cohort of patients receiving livers with no steatosis (24.2%). Similar to previous studies, higher rates of PRS, as seen in our microsteatosis group, resulted in a more complicated postoperative course . Patients in the microsteatosis group had higher rates of EAD (38.2%) than patients in the no steatosis group (23.0%).…”

Sarcopenia is associated with hypertension in older adults: a systematic review and meta-analysis

“…Six studies were conducted in China [ 17 , 18 , 27 , 30 ], two each in Republic of Korea [ 8 ] and Japan [ 25 ], and United States [ 9 , 24 , 33 , 34 ], one each in Turkey [ 29 ], Switzerland [ 26 ], Italy [ 7 ], and Spain [ 28 ]. Most of the studies were cross-sectional studies except two cohort studies [ 7 , 9 ].…”

Sarcopenia is associated with hypertension in older adults: a systematic review and meta-analysis

“…Six studies were conducted in China [18,19,28,31], two each in Republic of Korea [8] and Japan [26], and United States [9,25,34,35], one each in Turkey [30], Switzerland [27], Italy [7], and Spain [29].…”