Systemic versus nonsystemic reperfusion of the transplanted liver

Area of Science:

• Transplantation Surgery
• Cardiovascular Physiology
• Hepatology

Background:

• Reperfusion of transplanted livers can cause significant hemodynamic instability.
• Postreperfusion syndrome (PRS) is characterized by decreased mean arterial pressure (MAP), systemic vascular resistance (SVR), and heart rate, with increased central venous and pulmonary capillary wedge pressures.
• The left ventricular mechanoreceptor reflex (LVMRR) is implicated in mediating PRS, potentially triggered by atrial infusions during reperfusion.

Purpose of the Study:

• To evaluate a novel nonsystemic reperfusion (NSRP) technique for transplanted livers.
• To prevent activation of the LVMRR and mitigate PRS during liver transplantation.
• To compare the hemodynamic effects of NSRP versus standard systemic reperfusion (SRP).

Main Methods:

• NSRP involved discarding the initial 500-600 cc of portal blood during liver reperfusion.
• A cannula was inserted into the retrohepatic vena cava to facilitate NSRP.
• Hemodynamic parameters (MAP, SVR, heart rate) and serum potassium levels were monitored and compared between NSRP and SRP groups.

Main Results:

• The NSRP group (n=14) showed no significant changes in MAP, heart rate, or SVR, and no increase in serum potassium.
• The SRP group (n=14) experienced PRS in 42% of patients, with significant decreases in MAP and SVR, and increases in pulmonary capillary wedge pressure and serum potassium.
• NSRP demonstrated significantly less hemodynamic instability compared to SRP.

Conclusions:

• Nonsystemic reperfusion (NSRP) is an effective method for reducing hemodynamic instability during liver transplantation.
• NSRP minimizes the incidence of postreperfusion syndrome (PRS).
• NSRP should be considered the preferred reperfusion strategy for liver allografts.