Puchany AJ, Hilmi I. Post-reperfusion syndrome in liver transplant recipients: What is new in prevention and management? World J Crit Care Med 2025; 14(2): 101777 [DOI: 10.5492/wjccm.v14.i2.101777]
Corresponding Author of This Article
Ibtesam Hilmi, FRCA, MBChB, Doctor, Professor, School of Medicine, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, United States.hilmiia@upmc.edu
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Crit Care Med. Jun 9, 2025; 14(2): 101777 Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.101777
Post-reperfusion syndrome in liver transplant recipients: What is new in prevention and management?
Austin James Puchany, Ibtesam Hilmi
Austin James Puchany, Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Ibtesam Hilmi, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States
Ibtesam Hilmi, Department of Anesthesiology and Perioperative Medicine, Clinical and Translational Science Institute, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, United States
Author contributions: Puchany AJ performed literature review, writing – original draft; Hilmi I performed conceptualization, review, and editing.
Conflict-of-interest statement: Both authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ibtesam Hilmi, FRCA, MBChB, Doctor, Professor, School of Medicine, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, United States.hilmiia@upmc.edu
Received: September 26, 2024 Revised: November 22, 2024 Accepted: December 19, 2024 Published online: June 9, 2025 Processing time: 154 Days and 7.8 Hours
Abstract
Post-reperfusion syndrome (PRS) in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery. PRS can impact the short-term and long-term patient and graft outcomes. The definition of PRS has evolved over the years, from changes in arterial blood pressures and heart and/or decreases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS. However, all that did not reflect on the management of PRS or its impact on the outcomes. In recent years, new scientific techniques and new technology have been in the pipeline to better understand, manage and maybe prevent PRS. These new methods and techniques are still in the infancy, and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes. In this article, we will review the long history of PRS, its definition, etiology, management and most importantly the new advances in science and technology to prevent and properly manage PRS.
Core Tip: In this article, we review the newest updates in the definition, pathophysiology and risk factors for post-reperfusion syndrome (PRS). We discuss the latest recommendations for management of PRS. We analyze and the novel advances in liver donor preservation and their potential impact on prevention of PRS.
