[Post-reperfusion syndrome in orthotopic liver transplantation]

Post-reperfusion syndrome is the most common hemodynamic pattern in liver transplantation, manifesting mainly through decreased heart rate, mean arterial pressure and systemic vascular resistances. Five factors have been implicated in its genesis: the heart, the circulatory system, the metabolism, reflexes and surgery. Ventricular function, both right and left, has been shown to be normal during reperfusion, in which case the visceral and, especially, liver dilation that occurs would be the main cause of arterial hypotension. Patients in poor physical condition before the transplant are more likely to suffer the syndrome. Surgical technique (standard, venovenous shunt or preservation of the inferior vena cava), on the other hand, does not seem to play a major role. Prophylaxis with atropine prevents bradycardia but not hypotension. Administration of calcium chloride and sodium bicarbonate together with hyperventilation, mitigates symptoms. Finally, treatment with phenylephrine is rapidly effective.