Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis

Rayar, Michel; Sandri, Giovanni Battista Levi; Cusumano, Caterina; Locher, Clara; Houssel‐Debry, Pauline; Camus, Christophe; Lombard, Nicolas; Desfourneaux, Véronique; Lakéhal, M.; Meunier, Brigitte; Sulpice, Laurent; Boudjéma, Karim

doi:10.1002/lt.24650

Cited by 21 publications

(48 citation statements)

References 26 publications

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“…However, multivariate analysis showed only laboratory MELD and IAR to be individual determinants of perioperative transfusion of RBCs, whereas the interaction between IAR and TPCS was low ( P = 0.54). The beneficial effect of a TPCS, by using univariate analysis, has been described before (Table ) . These studies do not describe the order of reperfusion used during transplantation, although we assume that portal reperfusion was first.…”

Section: Discussionmentioning

confidence: 99%

“…The beneficial effect of a TPCS, by using univariate analysis, has been described before (Table 8). (7,(26)(27)(28) These studies do not describe the order of reperfusion used during transplantation, although we assume that portal reperfusion was first. A meta-analysis performed by Pratschke et al showed a significant beneficial effect of a TPCS on operative blood loss, but the I 2 values indicated substantial heterogeneity among the studies (P < 0.05), which could bring a potential bias to the results.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, less time may be needed for hemostasis and explantation of the native liver. Furthermore, a better hemodynamic (29) as Well as a recent study by rayar et al (28) showing tPcs versus no tPcs NOTE: Content is partially adopted from the meta-analysis by Pratschke et al (29) (↑) = significant more, (↓) = significant less, (=) = no significant difference. status during surgery due to less venous congestion may result in a more controlled situation.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

et al. 2019

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The use of a temporary portocaval shunt (TPCS) as well as the order of reperfusion (initial arterial reperfusion [IAR] versus initial portal reperfusion) in orthotopic liver transplantation (OLT) is controversial and, therefore, still under debate. The aim of this study was to evaluate outcome for the 4 possible combinations (temporary portocaval shunt with initial arterial reperfusion [A+S+], temporary portocaval shunt with initial portal reperfusion, no temporary portocaval shunt with initial arterial reperfusion, and no temporary portocaval shunt with initial portal reperfusion) in a center‐based cohort study, including liver transplantations (LTs) from both donation after brain death and donation after circulatory death (DCD) donors. The primary outcome was the perioperative transfusion of red blood cells (RBCs), and the secondary outcomes were operative time and patient and graft survival. Between January 2005 and May 2017, all first OLTs performed in our institution were included in the 4 groups mentioned. With IAR and TPCS, a significantly lower perioperative transfusion of RBCs was seen (P < 0.001) as well as a higher number of recipients without any transfusion of RBCs (P < 0.001). A multivariate analysis showed laboratory Model for End‐Stage Liver Disease (MELD) score (P < 0.001) and IAR (P = 0.01) to be independent determinants of the transfusion of RBCs. When comparing all groups, no statistical difference was seen in operative time or in 1‐year patient and graft survival rates despite more LTs with a liver from a DCD donor in the A+S+ group (P = 0.005). In conclusion, next to a lower laboratory MELD score, the use of IAR leads to a significantly lower need for perioperative blood transfusion. There was no significant interaction between IAR and TPCS. Furthermore, the use of a TPCS and/or IAR does not lead to increased operative time and is therefore a reasonable alternative surgical strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

et al. 2019

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“…Liver transplantation (LT), whether deceased donor (DDLT) or living donor (LDLT), is the most appropriate approach in adult and pediatric patients to treat end-stage liver disease and it is an effective therapeutic modality to increase patient survival time [ 1 ]. Nowadays, we observe an important improvement in medical (drugs) to prevent or treat transplant rejections and infections, better intensive care, and improved anesthetic, hemodynamic, and surgical approaches [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…A temporary bypass, the temporary portocaval shunt (TPCS), can be used and is associated with the use of the piggyback technique during hepatectomy to reduce pressure in the portal system and facilitate dissection of the retrohepatic vena cava [ 1 ]. The TPCS can have different anastomosis: end-to-side or passive portocaval tubing shunt.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Surgical Portosystemic Shunt in Liver Transplantation: Systematic Review and Meta-Analysis

et al. 2018

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BackgroundExpanded clinical and surgical techniques in liver transplantation can markedly improve patient and graft survival. The main purpose of this study was to evaluate the efficacy of intraoperative portocaval shunts in liver transplantation.Material/MethodsSearches were conducted in Cochrane, MEDLINE, and EMBASE databases, and updated in January 2018. The following specific outcomes of interest were defined and evaluated separated using 2 different reviews and meta-analyses for 1) hemi-portocaval shunt (HPCS) and 2) temporary portocaval shunt (TPCS). Comparative studies were analyzed separately for both surgical portocaval shunt modalities.ResultsOnly 1 well-designed randomized controlled trial was found. Most studies were retrospective or prospective. Initially, we found 1479 articles. Of those selected, 853 were from PubMed/MEDLINE, 32 were from Cochrane and 594 were from EMBASE. Our meta-analysis included a total of 3232 patients for all the included studies. Results found that 41 patients with HPCS experienced increased 1-year patient survival (OR 16.33; P=0.02) and increased 1-year graft survival (OR 17.67; P=0.01). The TPCS analysis with 1633 patients found patients had significantly shorter intensive care unit length of stay (days) (P=0.006) and hospital length of stay (P=0.02) and had decreased primary nonfunction (PNF) (OR 0.30, P=0.02) and mortality rates (OR 0.52, P=0.01).ConclusionsIntraoperative surgical portosystemic shunt in relation to liver transplantation with TPCS was able to prevent PNF, decrease hospital length of stay and unit care length of stay. Furthermore, in analyzing data for patients with HPCS, we observed increases in the 1-year graft and patient survival rates. More prospective randomized trials are needed to arrive at a more precise conclusion.

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Hypothermic Oxygenated Perfusion Improves Extended Criteria Donor Liver Graft Function and Reduces Duration of Hospitalization Without Extra Cost: The PERPHO Study

et al. 2021

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Few studies have evaluated the efficacy or the cost of hypothermic oxygenated perfusion (HOPE) in the conservation of extended criteria donor (ECD) grafts from donation after brain death (DBD) donors during liver transplantation (LT). We performed a prospective, monocentric study (NCT03376074) designed to evaluate the interest of HOPE for ECD‐DBD grafts. For comparison, a control group was selected after propensity score matching among patients who received transplants between 2010 and 2017. Between February and November 2018, the HOPE procedure was used in 25 LTs. Immediately after LT, the median aspartate aminotransferase (AST) level was significantly lower in the HOPE group (724UI versus 1284UI; P = 0.046) as were the alanine aminotransferase (ALT; 392UI versus 720UI; P = 0.01), lactate (2.2 versus 2.7; P = 0.01) There was a significant reduction in intensive care unit stay (3 versus 5 days; P = 0.01) and hospitalization (15 versus 20 days; P = 0.01). The incidence of early allograft dysfunction (EAD; 28% versus 42%; P = 0.22) was similar . A level of AST or ALT in perfusate >800UI was found to be highly predictive of EAD occurrence (areas under the curve, 0.92 and 0.91, respectively). The 12‐month graft (88% versus 89.5%; P = 1.00) and patient survival rates (91% versus 91.3%; P = 1.00) were similar. The additional cost of HOPE was estimated at € 5298 per patient. The difference between costs and revenues, from the hospital's perspective, was not different between the HOPE and control groups (respectively, € 3023 versus € 4059]; IC, –€ 5470 and € 8652). HOPE may improve ECD graft function and reduce hospitalization stay without extra cost. These results must be confirmed in a randomized trial.

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Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis

Cited by 21 publications

References 26 publications

Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

Intraoperative Surgical Portosystemic Shunt in Liver Transplantation: Systematic Review and Meta-Analysis

Hypothermic Oxygenated Perfusion Improves Extended Criteria Donor Liver Graft Function and Reduces Duration of Hospitalization Without Extra Cost: The PERPHO Study

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