Postreperfusion Syndrome During Liver Transplantation for Cirrhosis: Outcome and Predictors
Postreperfusion Syndrome During Liver Transplantation for Cirrhosis: Outcome and Predictors
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DOI：
10.1002/lt.21730
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发表时间：
2009-05-01
影响因子：
4.6
通讯作者：
Mantz, Jean
中科院分区：
文献类型：
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作者：
Paugam-Burtz, Catherine;Kavafyan, Juliette;Mantz, Jean
在原位肝移植（OLT）中，经常观察到门静脉解夹和肝脏再灌注后血压明显下降，称为灌注后综合征（PRS）。PRS的预测因素和临床后果尚不完全清楚。本研究的目的是确定肝硬化患者在OLT期间发生PRS及其发病率/死亡率的预测因素。在3年的时间里，研究了肝硬化患者所有连续的OLT手术。排除标准为急性肝功能衰竭、早期再移植、肝肾联合移植和活体供体相关移植。PRS被定义为在移植物再灌注后的前5分钟内，平均动脉压下降超过无肝期观察值的30%，持续时间超过1分钟。移植在保留下腔静脉的情况下进行，有或没有临时门静脉分流术。用双变量统计检验PRS与供体和受体人口统计数据、受体手术和术后结果之间的关系。通过多变量logistic回归分析确定PRS的独立预测因子。在纳入研究的75名患者中，20名患者（25%）发展为PRS。在多变量分析中，没有门静脉分流[优势比（95%可信区间）= 4.42(1.18-17.6)]和冷缺血持续时间[优势比（95%可信区间）= 1.34(1.07-1.72)]是PRS的独立预测因素。经历PRS的患者术后出现更多的肾功能衰竭，早期(
During orthotopic liver transplantation (OLT), a marked decrease in blood pressure following unclamping of the portal vein and liver reperfusion is frequently observed and is termed postreperfusion syndrome (PRS). The predictive factors and clinical consequences of PRS are not fully understood. The goal of this study was to identify predictors of PRS and morbidity/mortality associated with its occurrence during OLT in patients with cirrhosis. During a 3-year period, all consecutive OLT procedures performed in patients with cirrhosis were studied. Exclusion criteria were OLT for acute liver failure, early retransplantation, combined liver/kidney transplantation, and living-donor related transplantation. PRS was defined as a decrease in the mean arterial pressure of more than 30% of the value observed in the anhepatic stage, for more than 1 minute during the first 5 minutes after reperfusion of the graft. Transplantation was performed with preservation of the inferior vena cava with or without temporary portocaval shunt. Associations between PRS and donor and recipient demographic data, recipient operative and postoperative outcomes were tested with bivariate statistics. Independent predictors of PRS were determined in multivariable logistic regression analysis. Of the 75 patients included in the study, 20 patients (25%) developed PRS. In a multivariable analysis, absence of a portocaval shunt [odds ratio (95% confidence interval) = 4.42 (1.18-17.6)] and duration of cold ischemia [odds ratio (95% confidence interval) = 1.34 (1.07-1.72)] were independent predictors of PRS. Patients who experienced PRS displayed more postoperative renal failure and lower early (