{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T22:41:06Z","timestamp":1779230466232,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Postreperfusion syndrome (PRS) is a significant challenge in liver transplantation (LT), leading to severe circulatory and metabolic complications. Ischemic preconditioning (IPC), including remote IPC (RIPC), can mitigate ischemia-reperfusion injury, although its efficacy in LT remains unclear. This study evaluated the impact of paired RIPC, involving the application of RIPC to both the recipient and the living donor, on the incidence of PRS and the need for rescue epinephrine during living-donor LT (LDLT). Materials and Methods: This retrospective observational cohort analysis included 676 adult patients who had undergone elective LDLT between September 2012 and September 2022. After applying exclusion criteria and propensity score matching (PSM), 664 patients were categorized into the paired RIPC and non-RIPC groups. The primary outcomes were the occurrence of PRS and the need for rescue epinephrine during reperfusion. Results: The incidence of PRS and the need for rescue epinephrine were significantly lower in the paired RIPC group than in the non-RIPC group. Furthermore, the incidence of postoperative acute kidney injury was lower in the paired RIPC group. Multivariable logistic regression adjusted for propensity scores indicated that paired RIPC was significantly associated with a reduced occurrence of PRS (odds ratio: 0.672, 95% confidence interval: 0.479\u20130.953, p = 0.021). Conclusions: Paired RIPC, involving both the recipient and the living donor, effectively reduces the occurrence of PRS and the need for rescue epinephrine during LDLT. These findings suggest that paired RIPC protects against ischemia-reperfusion injury in LDLT. Future randomized controlled trials are needed to verify our results and to explore the underlying mechanisms of the protective effects of RIPC.<\/jats:p>","DOI":"10.3390\/medicina60111830","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T07:47:16Z","timestamp":1730965636000},"page":"1830","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Paired Remote Ischemic Preconditioning on Postreperfusion Syndrome in Living-Donor Liver Transplantation: A Propensity-Score Matching Analysis"],"prefix":"10.3390","volume":"60","author":[{"given":"Jaewon","family":"Huh","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1426-4651","authenticated-orcid":false,"given":"Min Suk","family":"Chae","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"527","DOI":"10.4097\/kjae.2015.68.6.527","article-title":"Postreperfusion syndrome during liver transplantation","volume":"68","author":"Jeong","year":"2015","journal-title":"Korean J. Anesthesiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1111\/j.1399-0012.2011.01568.x","article-title":"Incidence and predictors of post-reperfusion syndrome in living donor liver transplantation","volume":"26","author":"Chung","year":"2012","journal-title":"Clin. Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s005340100025","article-title":"Analysis of postrevascularization syndrome after orthotopic liver transplantation: The experience of an Australian liver transplantation center","volume":"8","author":"Nanashima","year":"2001","journal-title":"J. Hepatobiliary Pancreat. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1002\/lt.22227","article-title":"Release of cytokines and hemodynamic instability during the reperfusion of a liver graft","volume":"17","author":"Bezinover","year":"2011","journal-title":"Liver Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11892-016-0721-y","article-title":"Stress Hyperglycemia During Surgery and Anesthesia: Pathogenesis and Clinical Implications","volume":"16","author":"Palermo","year":"2016","journal-title":"Curr. Diabetes Rep."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chae, S., Choi, J., Lim, S., Choi, H.J., Park, J., Hong, S.H., Park, C.S., Choi, J.H., and Chae, M.S. (2020). Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: A propensity score-matching analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243873"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/1074248419892603","article-title":"Remote Ischemic Conditioning in Acute Myocardial Infarction and Shock States","volume":"25","author":"Kloner","year":"2020","journal-title":"J. Cardiovasc. Pharmacol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1097\/SLA.0000000000003498","article-title":"Effect of Remote Ischemic Preconditioning Conducted in Living Liver Donors on Postoperative Liver Function in Donors and Recipients Following Liver Transplantation: A Randomized Clinical Trial","volume":"271","author":"Jung","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Robertson, F.P., Fuller, B.J., and Davidson, B.R. (2017). An Evaluation of Ischaemic Preconditioning as a Method of Reducing Ischaemia Reperfusion Injury in Liver Surgery and Transplantation. J. Clin. Med., 6.","DOI":"10.3390\/jcm6070069"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, Y., Shen, J., Xiong, X., Xu, Y., Zhang, H., Huang, C., Tian, Y., Jiao, C., Wang, X., and Li, X. (2014). Remote ischemic preconditioning protects against liver ischemia-reperfusion injury via heme oxygenase-1-induced autophagy. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0098834"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1159\/000516608","article-title":"Ischemic Preconditioning for Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"37","author":"Jakubauskiene","year":"2021","journal-title":"Visc. Med."},{"key":"ref_12","first-page":"CD006315","article-title":"Ischaemic preconditioning for liver transplantation","volume":"2008","author":"Gurusamy","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/01.tp.0000188640.05459.37","article-title":"Ischemic preconditioning of cadaver donor livers protects allografts following transplantation","volume":"81","author":"Jassem","year":"2006","journal-title":"Transplantation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1093\/bja\/aeh195","article-title":"Effects of Pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: A randomized trial","volume":"93","author":"Schachtner","year":"2004","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/01.sla.0000167848.96692.ad","article-title":"Effects of 10 minutes of ischemic preconditioning of the cadaveric liver on the graft\u2019s preservation and function: The ying and the yang","volume":"242","author":"Azoulay","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jss.2014.05.046","article-title":"Combined remote ischemic perconditioning and local postconditioning on liver ischemia-reperfusion injury","volume":"192","author":"Costa","year":"2014","journal-title":"J. Surg. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.jss.2013.07.018","article-title":"Remote ischemic perconditioning protects the liver from ischemia-reperfusion injury","volume":"185","author":"Lotz","year":"2013","journal-title":"J. Surg. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"H1883","DOI":"10.1152\/ajpheart.00617.2006","article-title":"Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a KATP-dependent mechanism: First demonstration of remote ischemic perconditioning","volume":"292","author":"Schmidt","year":"2007","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Bang, J.Y., Kim, S.G., Oh, J., Kim, S.O., Go, Y.J., Hwang, G.S., and Song, J.G. (2019). Impact of Remote Ischemic Preconditioning Conducted in Living Kidney Donors on Renal Function in Donors and Recipients Following Living Donor Kidney Transplantation: A Randomized Clinical Trial. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050713"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/14017431.2016.1233351","article-title":"Review of remote ischemic preconditioning: From laboratory studies to clinical trials","volume":"50","author":"Anttila","year":"2016","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1002\/lt.23960","article-title":"Effect of remote ischemic postconditioning on patients undergoing living donor liver transplantation","volume":"20","author":"Kim","year":"2014","journal-title":"Liver Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"83","DOI":"10.12659\/AOT.902103","article-title":"Predictive Role of Intraoperative Plasma Fibrinogen for Postoperative Portal Venous Flow in Living Donor Liver Transplantation","volume":"22","author":"Chae","year":"2017","journal-title":"Ann. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.kint.2020.04.020","article-title":"Controversies in acute kidney injury: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference","volume":"98","author":"Ostermann","year":"2020","journal-title":"Kidney Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1097\/LVT.0000000000000173","article-title":"Early allograft dysfunction after living donor liver transplantation-current concepts and future directions","volume":"29","author":"Agrawal","year":"2023","journal-title":"Liver Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8256193","DOI":"10.1155\/2018\/8256193","article-title":"Predictive Role of Serum Cytokine Profiles in Acute Kidney Injury after Living Donor Liver Transplantation","volume":"2018","author":"Chae","year":"2018","journal-title":"Mediators Inflamm."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Jayant, K., Cotter, T.G., Reccia, I., Virdis, F., Podda, M., Machairas, N., Arasaradnam, R.P., Sabato, D.D., LaMattina, J.C., and Barth, R.N. (2023). Comparing High- and Low-Model for End-Stage Liver Disease Living-Donor Liver Transplantation to Determine Clinical Efficacy: A Systematic Review and Meta-Analysis (CHALICE Study). J. Clin. Med., 12.","DOI":"10.3390\/jcm12185795"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/lt.21730","article-title":"Postreperfusion syndrome during liver transplantation for cirrhosis: Outcome and predictors","volume":"15","author":"Kavafyan","year":"2009","journal-title":"Liver Transplant."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1016\/S0041-1345(99)00390-5","article-title":"Influence of surgical technique on postreperfusion syndrome during liver transplantation","volume":"31","author":"Acosta","year":"1999","journal-title":"Transplant. Proc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.1399-0012.2005.00458.x","article-title":"Comparison of two different techniques of reperfusion in adult orthotopic liver transplantation","volume":"20","author":"Gruttadauria","year":"2006","journal-title":"Clin. Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/j.1399-0012.2004.00231.x","article-title":"Influence of retrograde flushing via the caval vein on the post-reperfusion syndrome in liver transplantation","volume":"18","author":"Daniela","year":"2004","journal-title":"Clin. Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S0034-7094(10)70020-9","article-title":"Rapid and homogeneous reperfusion as a risk factor for postreperfusion syndrome during orthotopic liver transplantation","volume":"60","year":"2010","journal-title":"Rev. Bras. Anestesiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1097\/00000539-200204000-00009","article-title":"The effect of methylene blue on the hemodynamic changes during ischemia reperfusion injury in orthotopic liver transplantation","volume":"94","author":"Koelzow","year":"2002","journal-title":"Anesth. Analg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1002\/lt.23511","article-title":"Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation","volume":"18","author":"Ryu","year":"2012","journal-title":"Liver Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.surg.2020.09.036","article-title":"The learning curve for piggyback liver transplantation: Identifying factors challenging surgery","volume":"169","author":"Addeo","year":"2021","journal-title":"Surgery"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1161\/01.CIR.87.3.893","article-title":"Regional ischemic \u2018preconditioning\u2019 protects remote virgin myocardium from subsequent sustained coronary occlusion","volume":"87","author":"Przyklenk","year":"1993","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"9506","DOI":"10.3748\/wjg.v20.i28.9506","article-title":"Conventional, but not remote ischemic preconditioning, reduces iNOS transcription in liver ischemia\/reperfusion","volume":"20","author":"Winbladh","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1002\/lt.22204","article-title":"Effect of remote ischemic preconditioning on liver ischemia\/reperfusion injury using a new mouse model","volume":"17","author":"Yang","year":"2011","journal-title":"Liver Transplant."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1042\/CS20100598","article-title":"Nitric oxide is an essential mediator of the protective effects of remote ischaemic preconditioning in a mouse model of liver ischaemia\/reperfusion injury","volume":"121","author":"Yang","year":"2011","journal-title":"Clin. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1001\/jama.2015.4189","article-title":"Effect of remote ischemic preconditioning on kidney injury among high-risk patients undergoing cardiac surgery: A randomized clinical trial","volume":"313","author":"Zarbock","year":"2015","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e14463","DOI":"10.1111\/ctr.14463","article-title":"Takotsubo syndrome after liver transplantation: An association with intraoperatively administered epinephrine and fentanyl","volume":"35","author":"Yang","year":"2021","journal-title":"Clin. Transplant."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Horn\u00e9, F., Drefs, M., Schirren, M.J., Koch, D.T., Cepele, G., Jacobi, S.J., Payani, E., B\u00f6rner, N., Werner, J., and Guba, M.O. (2022). Hypothermic Oxygenated Machine Perfusion (HOPE) Prior to Liver Transplantation Mitigates Post-Reperfusion Syndrome and Perioperative Electrolyte Shifts. J. Clin. Med., 11.","DOI":"10.3390\/jcm11247381"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Jia, J., Nie, Y., Li, J., Xie, H., Zhou, L., Yu, J., and Zheng, S.S. (2020). A Systematic Review and Meta-Analysis of Machine Perfusion vs. Static Cold Storage of Liver Allografts on Liver Transplantation Outcomes: The Future Direction of Graft Preservation. Front. Med., 7.","DOI":"10.3389\/fmed.2020.00135"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1830\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:28:09Z","timestamp":1760113689000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,7]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["medicina60111830"],"URL":"https:\/\/doi.org\/10.3390\/medicina60111830","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,7]]}}}