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Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients
Importance This review explores proposed predictors, preventative measures, and treatment options for post‐reperfusion syndrome (PRS) in liver transplantation and provides updated data for clinicians. Objectives The review aims to understand the status and progress made regarding PRS during orthotop...
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| Published in: | Clinical transplantation 2023-06, Vol.37 (6), p.e15014-n/a |
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| container_issue | 6 |
| container_start_page | e15014 |
| container_title | Clinical transplantation |
| container_volume | 37 |
| creator | DeMaria, Samuel Nolasco, Lyle Igwe, Divya Jules, Robert St Bekki, Yuki Smith, Natalie K. |
| description | Importance
This review explores proposed predictors, preventative measures, and treatment options for post‐reperfusion syndrome (PRS) in liver transplantation and provides updated data for clinicians.
Objectives
The review aims to understand the status and progress made regarding PRS during orthotopic liver transplantation. Moreover, the predictors of PRS will be analyzed to highlight risk factors. Mediators of PRS and the modes of action of the currently available preventative and management agents that target particular PRS factors will be investigated.
Data Sources
Data is drawn from secondary sources from databases of peer‐reviewed journals. The bibliographies of select sources were also used to obtain additional data studies using the ‘snowball’ method.
Study Selection
The initial data search provided 1394 studies analyzed using PRISMA Extension for Scoping Reviews (PRISMA‐ScR) guidelines. After applying the eligibility criteria, 18 studies were fit for inclusion.
Results
The study identified that in addition to the severity of underlying medical conditions, other significant PRS predictors included patient age, sex, duration of cold ischemia, and the surgical technique. While the use of epinephrine and norepinephrine is well‐established, further preventative measures commonly involve specifically targeting known mediators of the syndrome, such as antioxidants, vasodilators, free radical scavengers, and anticoagulants. Current management strategies involve supportive therapy. Machine Perfusion may ultimately decrease the risk of PRS.
Conclusion
PRS still holds unknowns, including the underlying pathophysiology, controllable factors, and ideal management practices. There is a need for further study, particularly prospective trials since liver transplantation is the gold standard for treating end‐stage liver disease and the incidence of PRS remains high. |
| doi_str_mv | 10.1111/ctr.15014 |
| format | article |
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This review explores proposed predictors, preventative measures, and treatment options for post‐reperfusion syndrome (PRS) in liver transplantation and provides updated data for clinicians.
Objectives
The review aims to understand the status and progress made regarding PRS during orthotopic liver transplantation. Moreover, the predictors of PRS will be analyzed to highlight risk factors. Mediators of PRS and the modes of action of the currently available preventative and management agents that target particular PRS factors will be investigated.
Data Sources
Data is drawn from secondary sources from databases of peer‐reviewed journals. The bibliographies of select sources were also used to obtain additional data studies using the ‘snowball’ method.
Study Selection
The initial data search provided 1394 studies analyzed using PRISMA Extension for Scoping Reviews (PRISMA‐ScR) guidelines. After applying the eligibility criteria, 18 studies were fit for inclusion.
Results
The study identified that in addition to the severity of underlying medical conditions, other significant PRS predictors included patient age, sex, duration of cold ischemia, and the surgical technique. While the use of epinephrine and norepinephrine is well‐established, further preventative measures commonly involve specifically targeting known mediators of the syndrome, such as antioxidants, vasodilators, free radical scavengers, and anticoagulants. Current management strategies involve supportive therapy. Machine Perfusion may ultimately decrease the risk of PRS.
Conclusion
PRS still holds unknowns, including the underlying pathophysiology, controllable factors, and ideal management practices. There is a need for further study, particularly prospective trials since liver transplantation is the gold standard for treating end‐stage liver disease and the incidence of PRS remains high.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/ctr.15014</identifier><identifier>PMID: 37178452</identifier><language>eng</language><publisher>Denmark</publisher><subject>Adult ; Humans ; liver transplantation ; Liver Transplantation - adverse effects ; Prospective Studies ; Reperfusion - adverse effects ; Reperfusion Injury - etiology ; Reperfusion Injury - prevention & control ; reperfusion liver cirrhosis ; Retrospective Studies ; Syndrome</subject><ispartof>Clinical transplantation, 2023-06, Vol.37 (6), p.e15014-n/a</ispartof><rights>2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2854-d7acef1eaa26214f021536dc1587a27a83875cd3178ae9ebd1d6476bfaaf9ead3</cites><orcidid>0000-0002-6906-8762 ; 0000-0002-2984-3277</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fctr.15014$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fctr.15014$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37178452$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DeMaria, Samuel</creatorcontrib><creatorcontrib>Nolasco, Lyle</creatorcontrib><creatorcontrib>Igwe, Divya</creatorcontrib><creatorcontrib>Jules, Robert St</creatorcontrib><creatorcontrib>Bekki, Yuki</creatorcontrib><creatorcontrib>Smith, Natalie K.</creatorcontrib><title>Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>Importance
This review explores proposed predictors, preventative measures, and treatment options for post‐reperfusion syndrome (PRS) in liver transplantation and provides updated data for clinicians.
Objectives
The review aims to understand the status and progress made regarding PRS during orthotopic liver transplantation. Moreover, the predictors of PRS will be analyzed to highlight risk factors. Mediators of PRS and the modes of action of the currently available preventative and management agents that target particular PRS factors will be investigated.
Data Sources
Data is drawn from secondary sources from databases of peer‐reviewed journals. The bibliographies of select sources were also used to obtain additional data studies using the ‘snowball’ method.
Study Selection
The initial data search provided 1394 studies analyzed using PRISMA Extension for Scoping Reviews (PRISMA‐ScR) guidelines. After applying the eligibility criteria, 18 studies were fit for inclusion.
Results
The study identified that in addition to the severity of underlying medical conditions, other significant PRS predictors included patient age, sex, duration of cold ischemia, and the surgical technique. While the use of epinephrine and norepinephrine is well‐established, further preventative measures commonly involve specifically targeting known mediators of the syndrome, such as antioxidants, vasodilators, free radical scavengers, and anticoagulants. Current management strategies involve supportive therapy. Machine Perfusion may ultimately decrease the risk of PRS.
Conclusion
PRS still holds unknowns, including the underlying pathophysiology, controllable factors, and ideal management practices. There is a need for further study, particularly prospective trials since liver transplantation is the gold standard for treating end‐stage liver disease and the incidence of PRS remains high.</description><subject>Adult</subject><subject>Humans</subject><subject>liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Prospective Studies</subject><subject>Reperfusion - adverse effects</subject><subject>Reperfusion Injury - etiology</subject><subject>Reperfusion Injury - prevention & control</subject><subject>reperfusion liver cirrhosis</subject><subject>Retrospective Studies</subject><subject>Syndrome</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp1kE1LxDAQhoMoun4c_AOSo4LrJmmbtkdZ_AJBkfVcZpMpRtomJqmy_95o1ZtzmWF4eJh5CTnm7IKnWqjoL3jBeL5FZjyr6zljXGyTGauZSLPM9sh-CK9pK7ksdsleVvKyygsxI-7RozYqGjucU-fxHYdphkHT6BFinzbUttTZEKlHh74dQ0Jo2Aza2x6pGSjosUuUjy82WmcU7cw7-iSAIbgOksFBNMkUDslOC13Ao59-QJ6vr1bL2_n9w83d8vJ-rkRV5HNdgsKWI4CQguctE7zIpFa8qEoQJVRZVRZKZ-kPwBrXmmuZl3LdArQ1gs4OyOnkdd6-jRhi05ugsEvHoB1DIyqeFZKVUib0bEKVtyF4bBvnTQ9-03DWfAXcpICb74ATe_KjHdc96j_yN9EELCbgw3S4-d_ULFdPk_ITgBKIFg</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>DeMaria, Samuel</creator><creator>Nolasco, Lyle</creator><creator>Igwe, Divya</creator><creator>Jules, Robert St</creator><creator>Bekki, Yuki</creator><creator>Smith, Natalie K.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6906-8762</orcidid><orcidid>https://orcid.org/0000-0002-2984-3277</orcidid></search><sort><creationdate>202306</creationdate><title>Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients</title><author>DeMaria, Samuel ; Nolasco, Lyle ; Igwe, Divya ; Jules, Robert St ; Bekki, Yuki ; Smith, Natalie K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2854-d7acef1eaa26214f021536dc1587a27a83875cd3178ae9ebd1d6476bfaaf9ead3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Humans</topic><topic>liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Prospective Studies</topic><topic>Reperfusion - adverse effects</topic><topic>Reperfusion Injury - etiology</topic><topic>Reperfusion Injury - prevention & control</topic><topic>reperfusion liver cirrhosis</topic><topic>Retrospective Studies</topic><topic>Syndrome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DeMaria, Samuel</creatorcontrib><creatorcontrib>Nolasco, Lyle</creatorcontrib><creatorcontrib>Igwe, Divya</creatorcontrib><creatorcontrib>Jules, Robert St</creatorcontrib><creatorcontrib>Bekki, Yuki</creatorcontrib><creatorcontrib>Smith, Natalie K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DeMaria, Samuel</au><au>Nolasco, Lyle</au><au>Igwe, Divya</au><au>Jules, Robert St</au><au>Bekki, Yuki</au><au>Smith, Natalie K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2023-06</date><risdate>2023</risdate><volume>37</volume><issue>6</issue><spage>e15014</spage><epage>n/a</epage><pages>e15014-n/a</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><notes>mountsinaianesthesiology</notes><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><notes>ObjectType-Review-1</notes><abstract>Importance
This review explores proposed predictors, preventative measures, and treatment options for post‐reperfusion syndrome (PRS) in liver transplantation and provides updated data for clinicians.
Objectives
The review aims to understand the status and progress made regarding PRS during orthotopic liver transplantation. Moreover, the predictors of PRS will be analyzed to highlight risk factors. Mediators of PRS and the modes of action of the currently available preventative and management agents that target particular PRS factors will be investigated.
Data Sources
Data is drawn from secondary sources from databases of peer‐reviewed journals. The bibliographies of select sources were also used to obtain additional data studies using the ‘snowball’ method.
Study Selection
The initial data search provided 1394 studies analyzed using PRISMA Extension for Scoping Reviews (PRISMA‐ScR) guidelines. After applying the eligibility criteria, 18 studies were fit for inclusion.
Results
The study identified that in addition to the severity of underlying medical conditions, other significant PRS predictors included patient age, sex, duration of cold ischemia, and the surgical technique. While the use of epinephrine and norepinephrine is well‐established, further preventative measures commonly involve specifically targeting known mediators of the syndrome, such as antioxidants, vasodilators, free radical scavengers, and anticoagulants. Current management strategies involve supportive therapy. Machine Perfusion may ultimately decrease the risk of PRS.
Conclusion
PRS still holds unknowns, including the underlying pathophysiology, controllable factors, and ideal management practices. There is a need for further study, particularly prospective trials since liver transplantation is the gold standard for treating end‐stage liver disease and the incidence of PRS remains high.</abstract><cop>Denmark</cop><pmid>37178452</pmid><doi>10.1111/ctr.15014</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6906-8762</orcidid><orcidid>https://orcid.org/0000-0002-2984-3277</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Clinical transplantation, 2023-06, Vol.37 (6), p.e15014-n/a |
| issn | 0902-0063 1399-0012 |
| language | eng |
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| source | Wiley |
| subjects | Adult Humans liver transplantation Liver Transplantation - adverse effects Prospective Studies Reperfusion - adverse effects Reperfusion Injury - etiology Reperfusion Injury - prevention & control reperfusion liver cirrhosis Retrospective Studies Syndrome |
| title | Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients |
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