Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization1

Ducerf, C.; Mechet, Isabelle; Landry, Jean Luc; Delaroche, E.; Berthoux, N.; Bourdeix, O; Adham, Mustapha; Bizollon, T.; Baulieux, J.

doi:10.1016/s1072-7515(99)00227-6

Cited by 27 publications

(41 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Initial reperfusion with portal vein leads to higher values of preload parameters (CVP and mean pulmonary and wedge pressures) and, thus, higher cardiac output and mean systemic arterial pressure values than initial reperfusion of the graft with the hepatic artery. Durcef et al8 found similar results at the first reperfusion, but gave no information about the second unclamping. Nevertheless, hemodynamic and metabolic changes could have occurred on the second vascularization of the graft, as occurred in our study (Table 2).…”

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft

et al. 2006

View full text Add to dashboard Cite

We performed a prospective, randomized study of adult patients undergoing orthotopic liver transplantation, comparing hemodynamic and tissular oxygenation during reperfusion of the graft. In 30 patients, revascularization was started through the hepatic artery (i.e., initial arterial revascularization) and 10 minutes later the portal vein was unclamped; in 30 others, revascularization was started through the portal vein (i.e., initial portal revascularization) and 10 minutes later the hepatic artery was unclamped. The primary endpoints of the study were mean systemic arterial pressure and the gastric-end-tidal carbon dioxide partial pressure (PCO(2)) difference. The secondary endpoints were other hemodynamic and metabolic data. The pattern of the hemodynamic parameters and tissue oxygenation values during the dissection and anhepatic stages were similar in both groups At the first unclamping, initial portal revascularization produced higher values of mean pulmonary pressure (25 +/- 7 mm of Hg vs. 17 +/- 4 mm of Hg; P < 0.05) and wedge and central venous pressures. At the second unclamping, initial portal revascularization produced higher values of cardiac output and mean arterial pressure (87 +/- 15 mm of Hg vs. 79 +/- 15 mm of Hg; P < 0.05) and pulmonary blood pressure. Postreperfusion syndrome was present in 13 patients (42.5%) in the arterial group and in 11 patients (36%) in the portal group. During revascularization, the values of gastric and arterial pH decreased in both groups and recovered at the end of the procedure, but were more accentuated in the initial arterial revascularization group. In conclusion, we found that initial arterial revascularization of the graft increases pulmonary pressure less markedly, so it may be indicated for those patients with poor pulmonary and cardiac reserve. Nevertheless, for the remaining patients, initial portal revascularization offers more favorable hemodynamic and metabolic behavior, less inotropic drug use, and earlier normalization of lactate and pH values.

show abstract

Section: Discussionmentioning

confidence: 89%

“…As far as we know, few controlled studies comparing the hemodynamic effects of the order of graft revascularization have been performed. One study by a French group8 and 1 by a Scottish group have been published,9 but their data were inconclusive.…”

mentioning

confidence: 99%

Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft

et al. 2006

View full text Add to dashboard Cite

show abstract

“…In total, 11 studies could be included. Initial artery reperfusion versus initial portal reperfusion Six studies were included in this comparison: three randomized [1,23,4], two prospective nonrandomized [25,26] and one retrospective study [27]. Meta-analysis of the four included studies did not reveal evidence in favour of a specific reperfusion technique.…”

Section: Results Of the Literature Search And Meta-analysismentioning

confidence: 99%

“…The prolongation of warm ischaemia time and the anhepatic phase with SIMR may impair the graft function [3]. In the systematic review of Gurusamy et al [11], only five randomized controlled trial were included [1,10,23,24,28]. The comparisons performed included IAR vs. IPR, SIMR vs. IPR and RETR vs. SIMR.…”

Section: Reviewsmentioning

confidence: 99%

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

et al. 2013

View full text Add to dashboard Cite

SummaryIt remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, 508

show abstract

“…We prefer to do the arterial anastomosis first and then the portal anastomosis and to perform simultaneous arterial and portal revascularisation of the graft. Although some studies have suggested some advantages with initial arterial revascularisation [23], further studies are needed to confirm these findings.…”

Section: Vascular Anastomosesmentioning

confidence: 99%

Techniques of orthotopic liver transplantation

Lladó

Figueras

2004

HPB

View full text Add to dashboard Cite

Throughout the history of liver transplantation many improvements have been made in the field of surgical technique. It is beyond the scope of this paper to review all aspects of surgical technique in liver transplantation; thus, in this review we focus on the description of our current technique in most cases, which is orthotopic liver transplantation with preservation of the inferior vena cava and temporary portocaval shunt. We advocate this technique because it has been demonstrated that it achieves better haemodynamic stability during the anhepatic phase, transfusion can be reduced and renal function is improved. The different options for vascular anastomoses are described, particularly the options for arterial anastomoses in case of finding a non-adequate recipient hepatic artery. Technical possibilities for patients with preoperative portal vein thrombosis and the procedure in case of domino or sequential liver transplantation are further explained.

show abstract

Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization1

Cited by 27 publications

References 12 publications

Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft

Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft

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

Techniques of orthotopic liver transplantation

Contact Info

Product

Resources

About