Comparison of two different techniques of reperfusion in adult orthotopic liver transplantation

Abstract

In our transplant center, portal vein flush without vena caval venting provided a lower incidence of hemodynamic changes in the peri-operative period after liver transplantation and earlier recovery of the graft function.

Nafamostat Mesilate Attenuates Postreperfusion Syndrome during Liver Transplantation

“…The ICU length of stay was shorter in the NM group compared to the control group (control group vs. NM group, 7 [4][5][6][7][8][9][10][11][12][13][14] vs. 6 [4][5][6][7][8][9][10][11][12][13] days, p = 0.019). Univariate logistic regression analyses determined pH and serum potassium One patient in the control group and two patients in the NM group died due to acute graft rejection and subsequent multiorgan failure.…”

“…Many surgical and anesthetic techniques have been tried to prevent and attenuate the PRS with varying degrees of success (3,(12)(13)(14). The association between PRS and clinical factors such as characteristics of recipient and donor graft, surgical techniques and anesthetic management is yet to be determined.…”

The reperfusion syndrome: Have we made any progress?

“…It would seem to be intuitively obvious that any vascular toxins that might be flushed out of the new liver graft would drain directly into the right heart and would be very likely to cause hemodynamic disturbances. Therefore, many different surgical and anesthetic techniques have been developed to minimize the severity of PRS 8–14. This has included flushing the preservation fluid and other vasoactive molecules from the graft prior to reperfusion, adjusting the reperfusion sequence, and also adding some specific pharmacological interventions.…”

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

“…A more recent report by Gruttadauria from 2006 stated that a favorable outcome was achieved with a portal vein flush with lactated Ringer's solution without caval vein venting than in caval vein venting without portal vein flush . The endpoints in this retrospective analysis for the twenty‐five patients in each group were hemodynamic stability and graft function.…”

“…In the first category, laboratory parameters were tested, in which case transaminases and bilirubin were usually used to determine differences in graft damage and function . According to the potential benefit of various graft rinse protocols in preventing PRS, hemodynamic parameters were classified as the second common category , and the third category focused on graft function and survival data . Given the rather low evidence levels and the absence of appropriately designed RCT on the topic, the findings of the literature review failed to indicate which graft rinse protocol provides the best graft quality.…”