Sympathetic withdrawal is associated with hypotension after hepatic reperfusion
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10286_2013_Article_191.pdf
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Author(s)
Hwang, Gyu-Sam
Kim, Young Kug
Lee, Kichang
Date Issued
March 2013
Journal
Clinical Autonomic Research
Publisher
Springer-Verlag
Citation
Kim, Young-Kug et al. “Sympathetic Withdrawal Is Associated with Hypotension after Hepatic Reperfusion.” Clinical Autonomic Research 23.3 (2013): 123–131.
Version
Author's final manuscript
Abstract
Objective: Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS.
Methods: Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence.
Results: Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P < 0.001) and the ratio of low frequency power to high frequency power (LF/HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P < 0.001).
Interpretation: Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
Harvard University--MIT Division of Health Sciences and Technology
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DOI of Published Version
https://doi.org/10.1007/s10286-013-0191-0
