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Post-Reperfusion Syndrome in Liver Transplantation: Does a Caval Blood Flush Vent Help?
- Source :
-
Annals of transplantation [Ann Transplant] 2019 Dec 13; Vol. 24, pp. 631-638. Date of Electronic Publication: 2019 Dec 13. - Publication Year :
- 2019
-
Abstract
- BACKGROUND Post-reperfusion syndrome (PRS) during liver transplantation can range from a benign event to a profound hemodynamic excursion from baseline with significant morbidity. Multiple variables can be responsible for the diverse presentations. Over time, our group noticed that a blood flush of the liver graft via a caval vent (in addition to a standard chilled flush via the portal vein) appeared to result in a milder reperfusion effect. Attenuation of PRS via caval vent seemed to minimize hemodynamic instability and reduce metabolic derangements associated with reperfusion. MATERIAL AND METHODS This was a prospective observational pilot study of standard practice with the addition of lab values and hemodynamic evaluations. We methodically observed normal clinical flow in 20 adult orthotopic liver transplant recipients. We analyzed blood and fluid samples at set time intervals during the peri-reperfusion phase. RESULTS Sixteen out of 20 patients received a blood flush via caval venting. Mean arterial pressure (MAP) and heart rate were better preserved in the patient population that received a caval blood flush vent. Elevations in central venous pressure (CVP) were similar between the 2 groups. Lab values (blood gas, electrolyte, and hemoglobin) of the patients' blood were similar, with no notable differences. Analysis of the initial blood flushed through the liver graft proved to be hypothermic, acidotic, and hyperkalemic. CONCLUSIONS Pre-reperfusion caval venting in liver transplantation (in addition to a portal vent and a chilled LR/albumin portal flush solution) appears to have favorable hemodynamic effects. The literature on this technique is sparse and larger studies are needed.
- Subjects :
- Aged
Blood Pressure
Central Venous Pressure
Female
Heart Rate
Hemodynamics
Humans
Liver blood supply
Liver Circulation
Male
Middle Aged
Pilot Projects
Portal Vein
Prospective Studies
Reperfusion adverse effects
Reperfusion methods
Reperfusion Injury physiopathology
Syndrome
Venae Cavae
Liver Transplantation adverse effects
Liver Transplantation methods
Reperfusion Injury etiology
Reperfusion Injury prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 2329-0358
- Volume :
- 24
- Database :
- MEDLINE
- Journal :
- Annals of transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 31831725
- Full Text :
- https://doi.org/10.12659/AOT.920193