Early and Late Reperfusion Injury in Liver Transplant: A Case Series and Anesthetic Management Strategies

Postreperfusion syndrome is a recognized complication of liver transplant, characterized by acute cardiovascular instability following graft reperfusion . We present a case series of 2 deceased-donor liver transplant recipients who developed distinct patterns of reperfusion injury: a patient with early reperfusion syndrome and another patient with delayed (late) reperfusion instability. Both cases manifested significant hypotension and bradycardia or low cardiac output, requiring prompt anesthetic intervention with vasopressors and inotropes. Timely recognition, vigilant intraoperative monitoring, and tailored anesthetic management resulted in hemodynamic stabilization and favorable graft outcomes. This series highlights the importance of proactive anesthetic strategies for management of ischemia-reperfusion injury during liver transplant.