Siniscalchi A, Dante A, Spedicato S, Riganello L, Zanoni A, Cimatti M, Pierucci E, Bernardi E, Miklosova Z, Moretti C, Faenza S
Division of Anestesiology, University of Bologna, Bologna, Italy.
Transplant Proc. 2010 May;42(4):1197-9. doi: 10.1016/j.transproceed.2010.03.097.
BACKGROUND/AIMS: Liver transplantation (OLT) is a valid therapeutic option for patients with fulminant hepatic failure (FHF). The most critical phase during OLT is considered to be graft reperfusion, where in large changes in patient homeostasis occur. The aims of the present study were to evaluate the hemodynamic and cardiac changes among a large series of patients with FHF, to determine independent clinical predictors of the occurrence of postreperfusion syndrome (PSR) and its relationship to clinical and hemodynamic parameters and transplant outcomes.
Systemic hemodynamic and cardiac functions were evaluated by Swan-Ganz catheterization in 58 patients before OLT. The patients were divided into two subgroups on the basis of PSR, which was defined as a mean arterial blood pressure 30% lower than the immediate previous value lasting for at least 1 minute within 5 minutes after unclamping.
PSR occurred in 24 patients (41%). Significant differences upon bivariate analysis was observed for the Model for End-stage Liver Disease score, which was significantly higher among patients with PSR, namely 32 (range = 18-43) versus 23 (range = 12-32) (P = .001). Higher serum creatinine values were significantly different among patients with PSR: 1.4 (range = 1.2-2.2) versus 2.1 (range = 2.5-3.2) mg/dL (P < .01).
Systemic hemodynamic alterations of FHF progressively worsen with increasing severity of liver disease. PSR developed in approximately 40% of patients; its prevalence was significantly related to the severity of the disease. Finally, patients with renal failure showed greater risk to develop an PSR during OLT.
背景/目的：肝移植（OLT）是暴发性肝衰竭（FHF）患者有效的治疗选择。OLT过程中最关键的阶段被认为是移植肝再灌注阶段，此时患者体内稳态会发生巨大变化。本研究的目的是评估大量FHF患者的血流动力学和心脏变化，确定再灌注综合征（PSR）发生的独立临床预测因素及其与临床和血流动力学参数以及移植结局的关系。
对58例OLT术前患者通过Swan-Ganz导管插入术评估其全身血流动力学和心脏功能。根据PSR将患者分为两个亚组，PSR定义为在松开夹闭后5分钟内平均动脉血压比之前的值降低30%且持续至少1分钟。
24例患者（41%）发生了PSR。在二元分析中观察到终末期肝病模型评分存在显著差异，PSR患者的该评分显著更高，即32（范围 = 18 - 43）对比23（范围 = 12 - 32）（P = .001）。PSR患者的血清肌酐值更高，差异有统计学意义：1.4（范围 = 1.2 - 2.2）对比2.1（范围 = 2.5 - 3.2）mg/dL（P < .01）。
FHF的全身血流动力学改变随着肝病严重程度的增加而逐渐恶化。约40%的患者发生了PSR；其发生率与疾病严重程度显著相关。最后，肾衰竭患者在OLT期间发生PSR的风险更高。
