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Copyright ©The Author(s) 2016.
World J Gastroenterol. Jan 28, 2016; 22(4): 1551-1569
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1551
Table 4 Pharmacological prevention/treatment strategies
YearAuthorsTitleType of studyRationaleNo. subjectsDefinition of PRSEffectsJadad score
1995Bromley et al[57]Effects of intraoperative N-acetylcysteine in orthotopic liver transplantationProspectiveNAC could be beneficial in blunting the reperfusion effects of OLT50 (25 NAC vs 25 glucose)-NAC ↑ DO2 and CI; ↓ MAP and SVRI, no difference in reperfusion events or postoperative outcome3
1995Milroy SJ et al[61]Improved haemodynamic stability with administration of aprotinin during orthotopic liver transplantationRandomized Controlled TrialAprotinin ↓ fibrinolysis and inflammatory response55 (3 drop outs, 26 placebo, 26 aprotinin)-Aprotinin ↑ SVRI and ↓ CI in aprotinin group, no differences in vasopressors need5
1999Acosta et al[66]Atropine prophylaxis of the postreperfusion syndrome in liver transplantationProspectivePretreatment with atropine could partially prevent the developing of PRS41 (11 PRS vs 30 NPRS)30% drop in MAP within 5' lasting for at least 1' and up to more than 1 hNo significant changes in HR occurred, bradycardia was prevented. No change in MAP was recorded1
2001Molenaar et al[19]Reduced need for vasopressors in patients receiving aprotinin during orthotopic liver transplantationRandomized Controlled TrialAprotinin ↓ fibrinolysis and inflammatory response67 (24 high-dose aprotinin vs 21 regular-dose aprotinin vs 22 placebo)Syndrome characterized by a decrease in MAP and SVRI and an increase in CI and mean pulmonary artery pressureAprotinin ↓ need for vasopressors during OLT, especially during the early postreperfusion period3
2002Koelzow et al[58]The effect of methylene blue on the hemodynamic changes during ischemia reperfusion injury in orthotopic liver transplantationRandomized Controlled TrialMethylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger36 (18 MB 1.5 mg/kg vs 18 placebo )30% drop in MAP within 5' lasting for at least 1' and up to more than 1 hMB ↑ MAP and CI, ↓ epinephrine requirement, SVR did not change significantly, ↓ lactate levels1
2003Findlay et al[62]Aprotinin reduces vasoactive medication use during adult liver transplantationData obtained from patients enrolled in a previously completed, prospective, randomized, double-blind studyAprotinin ↓ fibrinolysis and inflammatory response63 (33 aprotinin vs 30 placebo)-↓ use of vasoactive infusions in the aprotinin group3
2011Fukazawa et al[59]The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft functionRetrospectiveMethylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger715 (105 MB bolus dose vs 610 control)30% drop in MAP within 5' lasting for at least 1' and up to more than 1 hNo differences in PRS incidence, post reperfusion MAP, need for vasopressors or transfusions and secondary outcomes1
2011Ryu et al[63]Nafamostat Mesylate attenuates post reperfusion syndromeRandomized Controlled TrialAprotinin has been proven effective in preventing PRS but it has been withdrawn from the market, Nafamostat is a protease inhibitor that acts similarly and could prove useful61 (31 treated vs 31 placebo, 42 excluded)30% drop in MAP within 5' lasting for at least 1' and up to more than 1 hNafamostat ↓ PRS incidence, hastened post reperfusion MAP recovery to normal values and ↓ need for early and late postreperfusion vasopressors5
2012Ryu et al[6]Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantationRandomized Controlled TrialPretreatment with a vasopressor should reduce PRS incidence and need for continous vasopressor support in late postreperfusion period96 (32 normal saline vs 33 epinephrine vs 31 phenylephrine)30% drop in MAP within 5' lasting for 1'↓ PRS incidence and ↓ need for vasopressors in late postreperfusion period in both pretreatment groups. Overshoot MAP in 6% of patients in both pretreatment groups. No differences in perioperative laboratory data and mortality5
2013Kong et al[64]Epsilon-aminocaproic acid improves postrecirculation hemodynamics by reducing intraliver activated protein C consumption in orthotopic liver transplantationRandomized Controlled TrialAPC has a role in coagulation and inflammation and could influence the levels of cytokines involved in the developement of PRS after reperfusion59 (31 EACA vs 28 controls)30% drop in MAP within 5' lasting for at least 1' and up to more than 1 h↓ PRS incidence, ↑ MAP, ↓ need for vasopressors, blood transfusion and FFP in EACA group5
2013Chung et al[68]Effects of magnesium pretreatment on the levels of T helper cytokines and on the severity of reperfusion syndrome in patients undergoing living donor liver transplantationRandomized Controlled TrialMagnesium has a protective role over ischemia-reperfusion injury40 (20 mg pretreatment vs 20 controls)30% drop in MAP within 5' lasting for at least 1' and up to more than 1 h↓ PRS incidence5
2014Fayed et al[67]Goal directed preemptive ephedrine attenuates the reperfusion syndrome during adult living donor liver transplantationRandomized Controlled TrialPreemptive ephedrine administration prereperfusion targeting a rational level of MAP may reduce the incidence of PRS100 (50 control vs 50 ephedrine)30% drop in MAP within 5' lasting for 1'↓ PRS incidence, need for postreperfusion vasoconstrictor support without over shooting of hemodynamic indices. ↓ need for postoperative mechanical ventilation5