INFLUENCE OF RETROGRADE REPERFUSION VIA THE CAVAL VEIN ON THE POSTREPERFUSION SYNDROME IN LIVER TRANSPLANTATION

Abstract

P483 Aims: The reperfusion phase during orthotopic liver transplantation is a critical event with sometimes profound hemodynamic and cardiac changes that may be responsible for intraoperative death. The postreperfusion syndrome, as first described by Aggarwal, was defined as a 30% decrease in mean arterial pressure lasting at least 1 minute within the first 5 minutes after beginning of reperfusion. We present the influence of a retrograde reperfusion technique in liver transplantation on the postreperfusion syndrome. Methods: Fifty-six liver transplantations in 53 patients were performed in piggy-back technique with retrograde reperfusion. After completing piggy-back anastomosis, the caval vein was declamped immediately and retrograde low pressure reperfusion of the graft with low oxygenated venous blood was established. To provide optimal retrograde liver reperfusion, the portal vein of the donor liver was not clamped when the portal anastomosis was performed. After completing portal anastomosis, the recipient portal vein was declamped immediately. During arterial anastomosis, the transplanted liver was antegradely perfused via the portal vein. When hepatic artery anastomosis was completed, the hepatic artery was declamped and arterial perfusion started. In order to evaluate postreperfusion syndrome, the course of mean blood pressure before and after reperfusion was examined in the patients. Results: We observed a postreperfusion syndrome in 2 patients (3.6%), 4 patients (7.1%) had a decrease in mean arterial pressure of 20-29%, 18 patients (32.2%) of 10-19%, 27 patients (48.2%) of 1-9% and 5 patients (8.9%) had a small increase in mean arterial pressure. Fifty out of 53 patients (94.34%) were alive and well on day 8 after liver transplantation. The one-year-survival rate was 85%. Conclusions: In our experience, retrograde reperfusion is highly effective for evacuating the perfusion fluid from the transplanted liver. We hypothesize that low pressure perfusion with low oxygenated blood reduces the production of free oxygen radicals. As sudden influx of cold, acidic and hyperkalemic blood and release of vasoactive substances and toxic agents from the grafted liver have been described as being responsible for postreperfusion syndrome, we suppose that retrograde reperfusion could diminish these effects. Our retrospective study showed that retrograde reperfusion seems to maintain stability during the reperfusion phase. Hemodynamic disturbances during liver transplantation were uncommon, leading us to suppose that the incidence of postreperfusion syndrome could be diminished with retrograde reperfusion technique.