Application of various surgical techniques in liver transplantation: a retrospective study

Chen, Zhitao; Wang, Ju; Chen, Chuanbao; Wang, Tielong; Yu, Jia; Hong, Xitao; Dong, Yuqi; Chen, Maogen; He, Xiaoshun

doi:10.21037/atm-21-1945

Cited by 6 publications

(3 citation statements)

References 42 publications

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“…The literature presents various surgical techniques that can be used during liver transplantation [ 14 ]. The surgical technique routinely used in our center involves total IVC clamping with an important decrease in preload and cardiac output with implications for cardiovascular status and anesthetic management.…”

Section: Discussionmentioning

confidence: 99%

The Hemodynamic Profile and Intraoperative Bleeding Impact on Liver Transplant Patients

Brezeanu,

Jercălău,

Andrei

et al. 2024

JPM

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Liver transplantation is the treatment of choice for end-stage liver disease and despite accumulated experience over the years, improved surgical techniques, better immunosuppression and adequate intensive care management, it still represents the greatest challenge for anesthesiologists. The aim of the study was the characterization of the hemodynamic profile of patients with liver cirrhosis undergoing liver transplantation with the help of the PiCCO system during the three surgical stages, the impact of bleeding on hemodynamic status and correlation between the amount of bleeding, lactate levels, severity scores and survival rate and complications. Another focus of this study was the amount of transfused blood products and their impact on postoperative complications. Our study included 70 patients who underwent liver transplantation in our center and were hemodynamically monitored with the PiCCO system. Data were processed using the Python 3.9 programming language. Results: The mean MELD severity score was 18 points. During surgery, significant variations in the hemodynamic parameters occurred. All patients had a decrease in cardiac output in the anhepatic phase, with 50% presenting a decrease of more than 40%. In total, 78% of patients showed a decrease in the global ejection fraction, with a median value of 30%.Overall, 75% of patients had a total blood loss of less than 6000 mL and 31 patients developed immediate postoperative complications with a 50% probability with blood loss exceeding 6500 mL. Seven patients (10%) did not survive after 30 days. An amount of 5 mmol/L of serum neohepatic lactate determines a 50% probability of complications. Conclusions: Surgical technique causes an important decrease in cardiac output. Intraoperative bleeding has a major impact on outcome and the first month represents a critical period after liver transplantation. Statistical tests describe the probability of 30/90-day survival and the occurrence of complications according to variables such as intraoperative bleeding and MELD severity score. Intraoperative transfusion correlates with the occurrence of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

The Hemodynamic Profile and Intraoperative Bleeding Impact on Liver Transplant Patients

Brezeanu,

Jercălău,

Andrei

et al. 2024

JPM

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“…Historically, OLT had been characterized by high blood loss and aggressive product‐based resuscitation; however, the resuscitative strategy has gradually shifted towards a more restrictive approach, which has been associated with improved recipient outcomes 2–6 . This paradigm, coupled with advancements in operative technique and graft preservation, has yielded an overall reduction in product utilization among OLT recipients, though the potential for massive intraoperative transfusion still exists 7–10 . The disparate range of blood product utilization in liver transplantation creates a logistical dilemma for operative and blood bank teams, characterized by an elusive balance between under‐preparation leading to delayed intraoperative resuscitation, and overpreparation risking waste of perishable blood products such as platelets (Plts).…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 , 4 , 5 , 6 This paradigm, coupled with advancements in operative technique and graft preservation, has yielded an overall reduction in product utilization among OLT recipients, though the potential for massive intraoperative transfusion still exists. 7 , 8 , 9 , 10 The disparate range of blood product utilization in liver transplantation creates a logistical dilemma for operative and blood bank teams, characterized by an elusive balance between under‐preparation leading to delayed intraoperative resuscitation, and overpreparation risking waste of perishable blood products such as platelets (Plts). Together, these conflicting priorities underscore the need for effective and applicable models to predict intraoperative transfusion requirements during OLT despite the complexities of end‐stage liver disease and liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship

et al. 2022

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Background Unanticipated transfusion requirements during liver transplantation can delay lifesaving intraoperative resuscitation and strain blood bank resources. Risk‐stratified preoperative blood preparation can mitigate these deleterious outcomes. Study Design and Methods A two‐tiered blood preparation protocol for liver transplantation was retrospectively evaluated. Eleven binary variables served as criteria for high‐risk (HR) allocation. Primary outcomes included red blood cell (RBC), plasma (FFP), and platelet (Plt) utilization. Secondary outcomes included product under‐ and overpreparation. Contingency tables for transfusion requirements above the population means were generated using 15 clinical variables. Modified protocols were developed and retrospectively optimized using the study population. Results Of 225 recipients, 102 received HR preoperative orders, which correlated to higher intraoperative transfusion requirements. However, univariate analysis identified only two statistical risk factors per product: Hgb ≤7.8 g/dl (p < .001) and MELD ≥38 (p = .035) for RBCs, Hgb ≤7.8 g/dl (p = .002) and acute alcoholic hepatitis (p = 0.015) for FFP, and Hgb ≤7.8 g/dl (p = .001) and normothermic liver preservation (p = .037) for Plts. Based on these findings, we developed modified protocols for individual products, which were evaluated retrospectively for their effectiveness at reducing under‐preparatory events while limiting product overpreparation. Cohort statistics were used to define the preparation strategy for each protocol. Retrospective comparative analysis demonstrated the superiority of the modified protocols by improving the under‐preparation rate from 24% to <10% for each product, which required a 1.56‐fold and 1.44‐fold increase in RBC and FFP overpreparation, respectively. Importantly, there was no difference in Plt overpreparation. Discussion We report translatable data‐driven blood bank preparation protocols for liver transplantation.

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Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis

Khajeh¹,

Ramouz²,

Aminizadeh³

et al. 2023

HPB

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Application of various surgical techniques in liver transplantation: a retrospective study

Cited by 6 publications

References 42 publications

The Hemodynamic Profile and Intraoperative Bleeding Impact on Liver Transplant Patients

The Hemodynamic Profile and Intraoperative Bleeding Impact on Liver Transplant Patients

Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship

Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis

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