A single-center experience with retrograde-reperfusion in liver transplantation

Abstract

Poor graft function secondary to injury by ischemia and reperfusion remains a major problem with regard to morbidity and mortality in clinical liver transplantation (LTX). Up to one fifth of patients suffer from poor initial liver function due to severe damage to hepatocytes. This situation leads either to primary nonfunction described in approximately 6% of LTX or to slow recovery. We present a new method of reperfusion during LTX. From July 1998 to July 2002, 42 LTX in 39 recipients, (10 female, 52 years old (26–70) were performed. LTX was carried out in piggy‐back technique. After completing the piggy‐back anastomosis, the caval vein was declamped immediately, and retrograde low pressure reperfusion of the graft with low oxygenated venous blood was established. Portal anastomosis was performed using a running suture. In order to provide optimal retrograde liver perfusion, no clamping of the donor portal vein was done. After completing portal anastomosis, the recipient portal vein was declamped immediately. During arterial anastomosis, the transplanted liver was antegradely perfused via the portal vein. After completing hepatic artery anastomosis, declamping of the hepatic artery was done and arterial perfusion started. No backtable or in‐situ‐flushing except the described reperfusion technique was performed. Forty‐two LTX in 39 recipients using piggy‐back technique and retrograde reperfusion via the caval vein followed by antegrade reperfusion via the portal vein were performed 38 out of 39 patients (97.44%) were alive and well at day 8 after LTX. One patient (2.56%) died of a pre‐existing portal vein thrombosis on day 2 after LTX. Three patients had to undergo retransplantation for hepatic artery thrombosis (7.14%). Liver enzymes, bilirubine, prothrombine time and AT III on day 1, 3, 5 and 8 after LTX showed favourable values. Median aspartate aminotransferase (ASAT) was 219 U/l on day 1 after LTX. One‐month survival rate was 95.23%, and 1‐year survival rate 87.88%. Two patients died of liver‐associated causes (5.12%). One patient died of a late hepatic artery thrombosis, and one more of rejection. No other severe case of rejection appeared. We can conclude that retrograde reperfusion might be highly sufficient method of removing perfusion fluid from the transplanted liver. Low pressure perfusion with low oxygenated blood might reduce the production of free oxygen radicals. Retrograde reperfusion via the caval vein and antegrade reperfusion via the portal vein seemed to lower postoperative liver enzyme values and to improve initial liver function after LTX.

Long-term quality of life of liver transplant recipients beyond 60 years of age

“…10/11). Study participants were recruited during their routine control visit at the outpatient ward of the Department of Surgery, Division for Transplantation, where all recipients who received a liver graft at the Medical University of Graz are routinely followed throughout their whole posttransplant period (Kniepeiss et al 2003).…”

Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature

“…The reviews [3,11] and case series [8,9] were excluded from the meta-analysis. In total, 11 studies could be included.…”

“…Two case series from the same surgical department and author were available [8,9]. In one of these studies, a total of 39 patients were included [8].…”

“…In one of these studies, a total of 39 patients were included [8]. One year after transplantation, 34 patients were alive.…”

“…The disadvantage of this technique is a prolongation of warm ischaemia and the anhepatic phase, which can be detrimental to postoperative graft function, survival and morbidity [6,7]. In the retrograde reperfusion technique, the vascular clamp on the inferior vena cava is removed immediately after completion of IVC anastomosis, allowing retrograde reperfusion during construction of portal vein anastomosis [8,9]. The advantage is that it shortens the warm ischaemia time, efficiently removes perfusion fluid from the graft before anterograde blood flow is re-established and results in reduced partial clamping time of the vena cava with a haemodynamic more stable patient, however, this technique is associated with a higher rate of biliary complications [3,10].…”