Post Reperfusion Syndrome In Liver Transplant After NormothermicPerfusion

Abstract

Introduction. Post reperfusion syndrome (PRS) is defined as severe haemodynamic instability, with a greater than 30% drop below the anhepatic mean arterial blood pressure (MAP) within 5 minutes of reperfusion sustained for at least 1 minute. It is an important factor in graft survival, recipient morbidity and mortality. The donor liver storage method may influence the incidence of PRS. Cooling the donor liver in cold storage (CS), is the conventional method. Normothermic Machine Perfusion
(NMP) is a novel method that may reduce the incidence of PRS.

Patients and Methods. Data from a previously published randomized trial comparing donor livers preserved with CS or NMP, using Organox machine (OX), was used to perform a retrospective analysis on 22 patients (11 CS, 11 OX). Recipient and donor demographics were evenly matched between patients. The primary outcome was the incidence of PRS with secondary outcomes being inotrope, blood product and fluid requirements. Data was examined for normality, and compared using Fisher exact test or Mann-Whitney.

Results. PRS occurred in 54% (n=6) of the CS group compared to 18% (n=2) of the OX group, p=0.183. The percentage drop in MAP was significantly lower for the OX group (15.8%) compared with the CS group (40%) p= 0.007. Total amount of adrenaline used was lower in the OX group compared with the CS group, p=0.088.

Total amount and number of patients on noradrenaline was similar between groups. Total fluids administered was less for the OX group (5090 mls) compared within the CS group (7419 mls) p=0.365. The OX group received less blood products in the post reperfusion phase compared to the CS group, however this was not statistically significant.

Discussions and Conclusions: We observed a reduced incidence of PRS in patients receiving NMP compared to CS livers, with improved haemodynamics and lower
adrenaline requirements.