Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 7-8, Pages: 467-470
https://doi.org/10.2298/SARH1508467A
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Anaphylaxis on graft reperfusion during orthotopic liver transplantation: A case study
Anđelić Nada (Clinical Center of Vojvodina, Clinic for Anaesthesia and Intensive Care, Novi Sad)
Erdeljan Svetlana (Clinical Center of Vojvodina, Clinic for Anaesthesia and Intensive Care, Novi Sad)
Popović Radmila (Clinical Center of Vojvodina, Clinic for Anaesthesia and Intensive Care, Novi Sad)
Božić Teodora (Clinical Center of Vojvodina, Clinic for Anaesthesia and Intensive Care, Novi Sad)
Introduction. Hemodynamic instability is a common occurrence during liver
transplantation (LT). Hypotension and hemodynamic instability during graft
reperfusion are most commonly consequences of the postreperfusion syndrome
(PRS). Case Outline. In this report, we present a case of severe
cardiovascular collapse leading to cardiac arrest which occurred in the
course of graft reperfusion during LT. Persistent hypotension, non-responsive
to regular measures such as volume filling and the use of vasopressors,
yielded the question of whether other mechanisms were involved in causing it.
Diffuse redness of the face and body, swelling of the face, lips and tongue
with tongue prolapse, accompanied with severe cardiovascular collapse
indicated that it was an anaphylactic reaction. This caused a dilemma as to
what instigated the reaction. The trigger may have been the pharmacological
substance administered during the graft reperfusion, or the one administered
immediately prior to the reperfusion. The substances in question would most
likely be either the University of Wisconsin preservation solution (UW),
which was administered during the reperfusion, or Hepatect, which the patient
received immediately prior to reperfusion. Conclusion. The clinical syndrome
resulting from degranulation of mast cells and basophils in anaphylaxis is
very similar to the PRS in LT. Clinical features play the most important role
in establishing a timely diagnosis and early treatment of anaphylaxis. Swift
administration of epinephrine reduces the chances of a fatal outcome. Better
information on both donor and recipient can improve the efficiency of therapy
and prophylaxis for anaphylaxis.
Keywords: liver transplantation, graft reperfusion, anaphylaxis