January’s Article of the Month, with commentary from Dr. Cara Crouch, examines a 15-year, 1,021-patient retrospective from Mount Sinai analyzing postreperfusion syndrome (PRS) during DBD liver transplantation. The authors identify four donor-side risk factors for PRS — donor age, donor BMI, moderate macrosteatosis, and cold ischemia time — and propose a PRS risk score that, combined with recipient MELD, may help optimize donor-to-recipient matching.
Key Findings
- Overall PRS incidence: 16.1% across 1,021 adult DBD liver transplants
- No recipient factors reached statistical significance for PRS association
- Four independent donor risk factors: donor age (OR 1.01), donor BMI (OR 1.04), moderate macrosteatosis 30–60% (OR 2.48), and cold ischemia time (OR 1.06)
- PRS independently predicted 30-day graft failure (HR 3.49, p < .001), alongside MELD score
- Combined PRS × MELD stratification produced four distinct 1-year graft survival profiles, with high PRS risk + high MELD performing worst
- Clinical implication: PRS risk evaluation may improve donor-to-recipient matching, with low-PRS / high-MELD pairings showing outcomes comparable to high-PRS / low-MELD
