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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1551-1569
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1551
Post reperfusion syndrome during liver transplantation: From pathophysiology to therapy and preventive strategies
Antonio Siniscalchi, Lorenzo Gamberini, Cristiana Laici, Tommaso Bardi, Giorgio Ercolani, Laura Lorenzini, Stefano Faenza
Antonio Siniscalchi, Lorenzo Gamberini, Cristiana Laici, Tommaso Bardi, Laura Lorenzini, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
Giorgio Ercolani, Division of Surgery, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
Author contributions: Siniscalchi A, Gamberini L, Laici C, Bardi T, Ercolani G, Lorenzini L and Faenza S solely contributed to this manuscript.
Supported by The Department of Anesthesiology of the University of Bologna.
Conflict-of-interest statement: The authors of this review certify that they have no affiliations with, or involvement in any organization or entity with any financial or non-financial interest, relating to the subject matter or the materials discussed in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Siniscalchi, MD, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. sinianest@libero.it
Telephone: +39-51-6363440
Received: April 17, 2015
Peer-review started: April 19, 2015
First decision: October 14, 2015
Revised: October 20, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 28, 2016
Abstract

This review aims at evaluating the existing evidence regarding post reperfusion syndrome, providing a description of the pathophysiologic mechanisms involved and possible management and preventive strategies. A PubMed search was conducted using the MeSH database, “Reperfusion” AND “liver transplantation” were the combined MeSH headings; EMBASE and the Cochrane library were also searched using the same terms. 52 relevant studies and one ongoing trial were found. The concept of post reperfusion syndrome has evolved through years to a multisystemic disorder. The implications of the main organ, recipient and procedure related factors in the genesis of this complex syndrome are discussed in the text as the novel pharmacologic and technical approaches to reduce its incidence. However the available evidence about risk factors, physiopathology and preventive measures is still confusing, the presence of two main definitions and the numerosity of possible confounding factors greatly complicates the interpretation of the studies.

Keywords: Liver transplantation, Reperfusion, Ischemia-reperfusion injury, Hemodynamics, Drug therapy

Core tip: Post reperfusion syndrome (PRS) is a serious intraoperative complication of liver transplantation that can influence recipient’s morbidity and mortality. This review provides a description of the evolution throughout the years of the concept of PRS, and gathers the existing evidence regarding the pathophysiologic mechanisms involved and the possible management and preventive strategies.