Increased liver graft weight is associated with a high incidence of postreperfusion syndrome in living donor liver transplantation: a retrospective cohort study.

Background: The postreperfusion phase during liver transplantation is among the most challenging periods for anesthesiologists. In living donor liver transplantation (LDLT), graft size varies considerably and may influence postreperfusion hemodynamics. This study aimed to evaluate the impact of absolute liver graft weight on the incidence of postreperfusion syndrome (PRS) and subsequent hemodynamic recovery following graft reperfusion. Methods: We retrospectively analyzed data from 100 adult patients who underwent LDLT. The incidence of PRS and hemodynamic variables were compared in relation to graft weight. Results: PRS occurred in 38% of patients. Multivariate analysis identified graft weight and Model for End-Stage Liver Disease-Na scores as significant predictors of PRS. A graft weight cutoff of 651 g best predicted PRS (area under the curve, 82.1%; 95% confidence interval [CI], 73.7%-90.5%). Patients were stratified into group A (≥651 g) and group B (<651 g). Surprisingly, group A had a significantly higher incidence of PRS but required less noradrenaline at intensive care unit transfer (0.20±0.07 vs. 0.28±0.17 μg/kg/min, P=0.003) and had a shorter duration of mechanical ventilation (748.15±322.37 vs. 1,156±1,020 minutes, P=0.007). Phenylephrine requirements during reperfusion were higher in group A (400 vs. 300 μg, P=0.01). Conclusions: An absolute graft weight ≥651 g was associated with a higher incidence of PRS, but counterintuitively this was linked to faster hemodynamic stabilization and reduced mechanical ventilation time. These findings underscore the complex interplay between graft size and postreperfusion physiology in LDLT.