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.
Highlights
The discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD)
According to the Organ Procurement and Transplantation Network of the United States (US) Department of Health and Human Services, the numbers of liver transplantations (LT) in the US have constantly been rising since the beginning of LT [1]: In 2016, a total of 7841 LTs were performed in the US
The decreasing organ donations combined with the persisting high morbidity and mortality of patients on the waiting list has led to a discrepancy between organ supply and demand [2, 4] and to the more frequent acceptance extended criteria donors (ECD) to the pool of eligible donors [5, 6]
Summary
The discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD). The decreasing organ donations combined with the persisting high morbidity and mortality of patients on the waiting list has led to a discrepancy between organ supply and demand [2, 4] and to the more frequent acceptance extended criteria donors (ECD) to the pool of eligible donors [5, 6]. The transplantation of ECD livers has led to a decrease in mortality for LT recipients on the wait lists at the cost of increased perioperative complication [23]. Both these factors have made it difficult to predict PRS. The quality of the donor organ and its role as risk factor for the occurrence of PRS as well as its associations with patients’ outcome have been neglected in the past
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