Antonio Siniscalchi1, Lorenzo Gamberini2, Tommaso Bardi1, Cristiana Laici1, Matteo Ravaioli3, Maria Letizia Bacchi Reggiani4, Stefano Faenza1. 1. Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. 2. Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. Electronic address: lorenzo.gamberini@studio.unibo.it. 3. Division of Hepatobiliary and Transplant Surgery, Hospital S. Orsola Malpighi, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. 4. Department of Diagnostic and Experimental Medicine and Statistics, Hospital S. Orsola Malpighi, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Abstract
Post-reperfusion syndrome during orthotopic liver transplantation, which definition best predicts postoperative graft failure and recipient mortality? PURPOSE: Post-reperfusion syndrome (PRS) is a serious complication of liver transplantation, at present two main definitions are in use, and they differ both clinically and temporally. The primary objective of this study was to evaluate these two definitions as risk factors for post-transplantation mortality and primary graft non-function. MATERIALS AND METHODS: We conducted a retrospective observational study on 794 patients undergoing orthotopic liver transplantation at our university hospital. The presence of PRS was evaluated according to both definitions and correlated with the end points: three months mortality, primary graft non-function (PGNF) and the combined outcome of the two. RESULTS: Both definitions proved to be independent risk factors for three months mortality and the combined outcome. The definition according to Aggarwal et al. was also an independent risk factor for PGNF when adjusted for the propensity score. The Hilmi definition, despite being more comprehensive, did not improve the predictivity of the Aggarwal definition for the evaluated outcomes. CONCLUSIONS: PRS proved to be an independent risk factor for post-transplantation mortality and occurrence of PGNF. The pathophysiological mechanisms of this entity are still not fully understood and preventive strategies could help in reducing patients and graft losses.
Post-reperfusion syndrome during orthotopic liver transplantation, which definition best predicts postoperative graft failure and recipient mortality? PURPOSE: Post-reperfusion syndrome (PRS) is a serious complication of liver transplantation, at present two main definitions are in use, and they differ both clinically and temporally. The primary objective of this study was to evaluate these two definitions as risk factors for post-transplantation mortality and primary graft non-function. MATERIALS AND METHODS: We conducted a retrospective observational study on 794 patients undergoing orthotopic liver transplantation at our university hospital. The presence of PRS was evaluated according to both definitions and correlated with the end points: three months mortality, primary graft non-function (PGNF) and the combined outcome of the two. RESULTS: Both definitions proved to be independent risk factors for three months mortality and the combined outcome. The definition according to Aggarwal et al. was also an independent risk factor for PGNF when adjusted for the propensity score. The Hilmi definition, despite being more comprehensive, did not improve the predictivity of the Aggarwal definition for the evaluated outcomes. CONCLUSIONS: PRS proved to be an independent risk factor for post-transplantation mortality and occurrence of PGNF. The pathophysiological mechanisms of this entity are still not fully understood and preventive strategies could help in reducing patients and graft losses.
Authors: William D Stoll; William R Hand; Kenneth D Chavin; Dodson H Felton; Beth O Wolf; Grayce P Davis; Norman R Harvey; Joseph R Whiteley; Robert A Mester; Eric D Bolin Journal: Ann Transplant Date: 2019-12-13 Impact factor: 1.530