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% confidenceinterval [CI], 73.7%–90.5%). Patients were stratified into group A (≥651 g) and group B (<651g). 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 incidenceof 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.

Disulfiram is the commonly prescribed drug for the treatment of alcohol dependence. It's major metabolite (diethyldithiocarbamate) is an inhibitor of dopamine-betahydroxylase, an enzyme that catalyzes the metabolism of dopamine to norepinephrine resulting in psychosis. We recommend that disulfiram should be used at the lowest effective dose, possibly 250 mg daily and caution should be taken while prescribing disulfiram for patients with personal and familial antecedents of psychosis.
Alcoholism ; Disulfiram* ; Dopamine ; Humans ; Metabolism ; Norepinephrine ; Psychotic Disorders*