A Novel Parameter Derived From Photoplethysmographic Pulse Wave to Predict Risk of Postreperfusion Syndrome

Abstract BackgroundPostreperfusion syndrome (PRS), observed after reperfusion of the grafted liver, was associated with poor outcome. The end-stage liver disease (ESLD) with autonomic dysfunction in the cardiovascular system has greater risk of developing of PRS, due to the poor ability in sympathetic vasoconstriction. Surgical Stress Index (SSI) is a novel parameter derived from photoplethysmographic pulse wave to assess central sympathetic modulation in awake volunteers. In this study, we determined the relationship between SSI values and the risk of developing of PRS during orthotopic liver transplantation.MethodsWe retrospectively studied 163 patients who had undergone OLT, and divided the patients into PRS group and non-PRS group. SSI and related parameters were determined 5min before and after clamping of the inferior vena cava, the occurrence of PRS were recorded during reperfusion.ResultsThe clamping of the inferior vena cava modified the SSI significantly, accompanied with significant hemodynamic response. The SSI increased significantly after clamping (47.0 (43.0-49.0 ) vs.81.0(69.5-89.0), p<0.001). The SSI increased by 45.3% at 5min after clamping of the inferior vena cava in the PRS group, as opposed to 81.7% in the non-PRS group (P = 0.037). PRS occurred in only 19.4% of patients in whom the SSI increased by more than 50%. Based on a multivariate analysis, percentage of the variation in the SSI was associated with a significant increased risk in developing the PRS (OR 2.49, 95% CI 1.15-5.02; P=0.021).ConclusionsSSI can sensitively indicate the central sympathetic modulation function during liver transplantation procedure. SSI might be a sensitive marker of risk of developing PRS.