Reperfusão rápida e homogênea como fator de risco da síndrome pós-reperfusão hepática durante transplante ortotópico de fígado

Lucas Cordoví de Armas; Rosa E. Jiménez Paneque; Boris Gala López; Edin Ismael Rápalo Romero; Ydriss Añuez Castillo; Marina Beatriz Vallongo Menéndez

doi:10.1590/S0034-70942010000200007

Scientific Article

Reperfusão rápida e homogênea como fator de risco da síndrome pós-reperfusão hepática durante transplante ortotópico de fígado

Rapid and homogeneous reperfusion as a risk factor for postreperfusion syndrome during orthotopic liver transplantation

Lucas Cordoví de Armas; Rosa E. Jiménez Paneque; Boris Gala López; Edin Ismael Rápalo Romero; Ydriss Añuez Castillo; Marina Beatriz Vallongo Menéndez

http://dx.doi.org/10.1590/S0034-70942010000200007 Braz J Anesthesiol, vol.60, n2, p.154-158, 2010

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Resumo

JUSTIFICATIVA E OBJETIVOS: A revascularização do órgão transplantado é um momento crucial no transplante ortotópico de fígado (TOF). Aproximadamente um terço dos pacientes desenvolve síndrome pós-reperfusão hepática (SPR), uma combinação de hipotermia, desordens metabólicas e instabilidade cardiovascular que podem levar à parada cardíaca. O objetivo deste estudo foi avaliar a relação velocidade-qualidade (RVQ) da reperfusão do órgão transplantado como fator independente de predição da SPR. MÉTODOS: Todos os pacientes elegíveis que se submeteram ao TOF em nossa instituição de 1987 a março de 2009 foram incluídos. O OR ajustado da associação RVQ-SPR foi obtido através do modelo de regressão logística, incluindo oito variáveis de confusão. RESULTADOS: A proporção de pacientes que desenvolveram SPR foi maior nos pacientes com RVQ identificada como boa (75,8%) do que naqueles com RVQ média ou baixa; o risco relativo ao comparar a RVQ de boa qualidade com a RVQ de baixa qualidade foi de 12,9 (IC 95%: 2,1 - 528,8). O OR ajustado foi de 132,9 (IC 95%: 10,5 - 1688,6) quando a RVQ de boa e baixa qualidade foram comparadas e de 90,9 (IC 95%: 13,8-645,2) comparando a RVQ boa com a intermediária. CONCLUSÕES: De acordo com nossos resultados, a RVQ pode ser considerada um bom fator preditivo da SPR.

Palavras-chave

CIRURGIA, Transplante, FATORES DE RISCO, REPERFUSÃO

Abstract

BACKGROUND AND OBJECTIVES: The revascularization of the graft remains as a crucial instant of the orthotopic liver transplantation (OLT) surgical procedure. About a third of the recipients suffer the postreperfusion syndrome (PRS), a combination of hypothermia, metabolic disorders and cardiovascular instability potentially leading to cardiac arrest. The objective of this study was to evaluate the speed-quality (SQR) of the graft`s reperfusion as an independent predictor of PRS. METHODS: All eligible patients receiving an OLT in our institution from 1987 to march 2009 were included. The adjusted OR for SQR-PRS association was obtained by means of logistic regression modeling including eight potential confounders. RESULTS: The proportion of recipients suffering PRS was highest when the SQR was identified as good (75.8%) compared to those with middle or poor SQR; the relative risk comparing good SQR with poor SQR was 12.9 (CI 95%: 2.1-528.8). The adjusted OR was 132.9 (95% CI: 10.5-1688.6) when comparing good with bad SQR and 90.9 (95% CI: 13.8-645.2) when comparing good with intermediate SQR. CONCLUSIONS: According to our results, SQR can be considered an unambiguous predictor of PRS.

Keywords

SURGERY, Transplantation, RISK FACTORS, REPERFUSION

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Reperfusão rápida e homogênea como fator de risco da síndrome pós-reperfusão hepática durante transplante ortotópico de fígado

Rapid and homogeneous reperfusion as a risk factor for postreperfusion syndrome during orthotopic liver transplantation

Lucas Cordoví de Armas; Rosa E. Jiménez Paneque; Boris Gala López; Edin Ismael Rápalo Romero; Ydriss Añuez Castillo; Marina Beatriz Vallongo Menéndez

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