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Factors Associated With Postreperfusion Syndrome in Living Donor Liver Transplantation: A Retrospective Study
Anesthesia & Analgesia ( IF 5.7 ) Pub Date : 2022-07-05 , DOI: 10.1213/ane.0000000000006002
Kaoru Umehara 1 , Yuji Karashima 1 , Tomoharu Yoshizumi 2 , Ken Yamaura 3
Affiliation  

s on risk factors for PRS in brain-dead donor LT, there are a few reports on those in living donor LT. Therefore, we retrospectively reviewed the factors associated with PRS to contribute to the anesthetic management so as to reduce PRS during living donor LT. METHODS: After approval by the ethics committee of our institution, 250 patients aged ≥20 years who underwent living donor LT at our institution between January 2013 and September 2018 were included in the study. A decrease in mean arterial pressure of ≥30% within 5 minutes after portal vein reperfusion was defined as PRS, and estimates and odds ratio (OR) for PRS were calculated using logistic regression. The backward method was used for variable selection in the multivariable analysis. RESULTS: Serum calcium ion concentration before reperfusion (per 0.1 mmol/L increase; OR, 0.74; 95% confidence interval (CI), 0.60–0.95; P < .001), preoperative echocardiographic left ventricular end-diastolic diameter (per 1-mm increase: OR, 0.90; 95% CI, 0.85–0.95; P < .001, men [versus women: OR, 2.45; 95% CI, 1.26–4.75; P = .008]), mean pulmonary artery pressure before reperfusion (restricted cubic spline, P = .003), anhepatic period (restricted cubic spline, P = .02), and graft volume to standard liver volume ratio (restricted cubic spline, P = .03) were significantly associated with PRS. CONCLUSIONS: In living donor LT, male sex and presence of small left ventricular end-diastolic diameter, large graft volume, and long anhepatic period are associated with PRS, and a high calcium ion concentration and low pulmonary artery pressure before reperfusion are negatively associated with PRS....

中文翻译:

活体肝移植中与再灌注后综合征相关的因素:一项回顾性研究

关于脑死亡供体 LT 中 PRS 的危险因素,有一些关于活体供体 LT 的报告。因此,我们回顾性地回顾了与 PRS 相关的因素,以有助于麻醉管理,从而减少活体供体 LT 期间的 PRS。方法:经我院伦理委员会批准,2013年1月至2018年9月在我院接受活体肝移植的年龄≥20岁的患者250例纳入研究。门静脉再灌注后 5 分钟内平均动脉压下降≥30% 被定义为 PRS,并使用逻辑回归计算 PRS 的估计值和优势比 (OR)。后向法用于多变量分析中的变量选择。结果:再灌注前血清钙离子浓度(每增加 0.1 mmol/L;OR,0.74;95% 置信区间 (CI),0.60–0.95;P < .001),术前超声心动图左心室舒张末期直径(每增加 1 mm:OR,0.90;95% CI,0.85-0.95;P < .001,男性 [与女性:OR,2.45;95% CI , 1.26–4.75; P = .008])、再灌注前的平均肺动脉压(限制​​三次样条,P = .003)、无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(受限三次样条,P = .03)与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS.... 术前超声心动图左心室舒张末期直径(每增加 1 毫米:OR,0.90;95% CI,0.85–0.95;P < .001,男性 [与女性相比:OR,2.45;95% CI,1.26–4.75;P = .008])、再灌注前平均肺动脉压(限制​​三次样条,P = .003)、无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(限制三次样条,P = .03) 与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS.... 术前超声心动图左心室舒张末期直径(每增加 1 毫米:OR,0.90;95% CI,0.85–0.95;P < .001,男性 [与女性相比:OR,2.45;95% CI,1.26–4.75;P = .008])、再灌注前平均肺动脉压(限制​​三次样条,P = .003)、无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(限制三次样条,P = .03) 与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS.... 90; 95% CI,0.85–0.95;P < .001,男性 [与女性相比:OR,2.45;95% CI,1.26–4.75;P = .008])、再灌注前平均肺动脉压(限制​​三次样条,P = .003)、无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(限制三次样条, P = .03) 与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS.... 90; 95% CI,0.85–0.95;P < .001,男性 [与女性相比:OR,2.45;95% CI,1.26–4.75;P = .008])、再灌注前平均肺动脉压(限制​​三次样条,P = .003)、无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(限制三次样条, P = .03) 与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS.... 无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(限制三次样条,P = .03)与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS.... 无肝期(限制三次样条,P = .02)和移植物体积与标准肝体积比(限制三次样条,P = .03)与 PRS 显着相关。结论:在活体肝移植中,男性、左心室舒张末期直径小、移植物体积大、无肝期长与 PRS 相关,再灌注前高钙离子浓度和低肺动脉压与 PRS 呈负相关。 PRS....
更新日期:2022-07-05
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