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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Vasoplegic syndrome during liver transplantation
Zhongping Cao1, Yuqi Gao, Guocai Tao
1Department of Anesthesia, The Southwest Hospital of The Third Military Medical University, Chongqing, 400038, China.
Anesthesia and Analgesia
|May 19, 2009
Summary
A liver transplant patient experienced severe low blood pressure (vasoplegic syndrome) unresponsive to standard drugs. Treatment with methylene blue and norepinephrine successfully managed this critical condition.
Area of Science:
- Hepatology
- Cardiovascular Surgery
- Anesthesiology
Background:
- Liver transplantation is a complex procedure for end-stage liver disease.
- Decompensated cirrhosis, particularly with chronic hepatitis B, presents significant perioperative risks.
- Vasoplegic syndrome is a rare but life-threatening complication characterized by hypotension and low systemic vascular resistance.
Observation:
- A 56-year-old woman with chronic hepatitis B and decompensated cirrhosis developed profound hypotension (60/40 mm Hg) during the neohepatic phase of liver transplantation.
- The hypotension was refractory to conventional vasoconstrictive agents.
- The patient exhibited a hyperdynamic state with high cardiac output and low systemic vascular resistance, indicative of vasoplegic syndrome.
Findings:
- Intravenous methylene blue (0.5 mg/kg) combined with norepinephrine administration was effective in reversing the vasoplegic syndrome.
- Hemodynamic parameters, including arterial blood pressure, normalized following the intervention.
Implications:
- Methylene blue is a potential therapeutic option for managing refractory vasoplegic syndrome in liver transplant recipients.
- Early recognition and targeted treatment of vasoplegic syndrome are crucial for improving outcomes in orthotopic liver transplantation.
- This case highlights the importance of considering vasoplegic syndrome in hypotensive liver transplant patients unresponsive to standard therapies.
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