Simultaneous arterial and portal revascularization in liver transplantation

Massarollo, Paulo Celso Bosco; Mies, Sérgio; Raia, Silvano

doi:10.1016/s0041-1345(98)00854-9

Cited by 30 publications

(38 citation statements)

References 10 publications

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“…In contrast, no advantage of either of the two reperfusion protocols (SIMR vs. IPR) was observed by Polak et al [29], especially with respect to the incidence of nonanastomotic biliary lesions. However, in this study, cold ischaemia time was shorter than in [4] and [5] (8.7 h vs. 10.7 h and 13.3 h respectively). The conclusion drawn was that the order of revascularization does not influence the incidence of ITBL when the cold ischaemia time is kept short (<9 h).…”

Section: Discussioncontrasting

confidence: 72%

“…All observed complications were nonanastomotic biliary lesions (P = 0.03). Massarollo et al also compared SIMR vs. IPR [5]. Biliary complications occurred in one patient after SIMR (anastomotic stricture) and in nine (eight anastomotic and one nonanastomotic) after IPR (P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Four studies were included in this comparison: one randomized study [28] and three retrospective studies [4,5,29]. Although no differences were observed for mortality and rate of retransplantation within the studies, significant differences are reported for biliary complications and are therefore presented in detail: biliary complications occurred in four patients in the SIMR group and in nine in the IPR group (P = 0.05) in the study performed by Adani et al [28].…”

Section: Simultaneous Reperfusion Versus Initial Portal Reperfusionmentioning

confidence: 99%

“…All observed complication were nonanastomotic biliary lesions (P = 0.03). Massarollo et al [5] included a total of 76 patients (50 SIMR vs. 26 IPR). Biliary complications occurred in only one patient after SIMR (anastomotic stricture).…”

Section: Simultaneous Reperfusion Versus Initial Portal Reperfusionmentioning

confidence: 99%

“…The disadvantage of IPR is an increased risk of warm ischaemic damage to the bile ducts (ischaemic type biliary lesion, ITBL), where the blood supply depends solely on the hepatic artery [3]. Similar to IAR, the motivation for SIMR is to reduce the incidence of biliary complications [4,5]. An additional advantage of SIMR is that anastomosis can be repaired without completely interrupting blood flow to the graft, in case there are problems with one of the anastomoses.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Simultaneous Reperfusion Versus Initial Portal Reperfusionmentioning

confidence: 99%

Section: Simultaneous Reperfusion Versus Initial Portal Reperfusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Randomized trial comparing pulmonary alterations after conventional with venovenous bypass versus piggyback liver transplantation

et al. 2004

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During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is crossclamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB. The aim of this study is to compare pulmonary alterations after conventional with VVB versus piggyback LT. Sixtyseven patients were randomized for conventional VVB (n ‫؍‬ 34) or piggyback (n ‫؍‬ 33) LT. Pulmonary static compliance (C st ) and Pa O2 /F IO2 ratio were measured preand post-LT. Chest X-rays were obtained daily from the 1st to the 5th postoperative day. Pre-and post-LT C st were 73.4 ؎ 36.0 mL/cm H 2 O and 59.7 ؎ 22.0 mL/cm H 2 O in the conventional group and 69.1 ؎ 20.0 mL/cm H 2 O and 58.7 ؎ 27.1 mL/cmH 2 O in the piggyback group. The difference between the two groups was not significant (P ‫؍‬ .702). C st significantly decreased after LT (P ‫؍‬ .008). The pre-and post-LT Pa O2 /F IO2 were 455.6 ؎ 126.6 mm Hg and 463.1 ؎ 105.9 mm Hg in the conventional group and 468.9 ؎ 114.1 mm Hg and 483.3 ؎ 119.8 mm Hg in the piggyback group. The difference among the two groups was not significant (P ‫؍‬ 0.331). There was no significant difference after LT (P ‫؍‬ .382). Upon the radiological evaluation, piggyback group presented a higher frequency of pulmonary infiltrates (80.6% vs. 50.0%; P ‫؍‬ .025). In conclusion, piggyback LT recipients have a higher rate of pulmonary infiltrates when compared to those operated upon using the conventional VVB method. (Liver Transpl 2004;10:425-433.) C urrently, 2 main methods of liver transplantation (LT) are employed. 1 In the conventional method, the retrohepatic portion of the inferior vena cava (IVC) is cross-clamped and resected in block with the native liver. This maneuver can lead to pulmonary complications secondary to the temporary reduction of the venous blood return of the lower extremities and splanchnic bed. 2 Patients with poor hemodynamic tolerance to IVC and portal vein clamping will require fluid infusion during the anhepatic phase. 2 After graft reperfusion, the restoration of the venous return results in a sudden central volume overload that can cause pulmonary edema. 2 A concurrent mechanism is the release into the systemic circulation of proinflammatory substances produced in the graft itself during the ischemia-reperfusion injury, and in the obstructed venous beds during blood stagnation. 3 These substances may produce left ventricle dysfunction, increase pulmonary capillary pressure, and alter capillary permeability. 3 All these actions can contribute to pulmonary dysfunction.To overcome these disorders, venovenous bypass (VVB) is usually indicated, allowing the diversion of the IVC and portal blood flow to the superior vena cava. 2 Despite these advantages, VVB can also cause pulmonary complications. Although rare, some can be fatal, like air or thrombotic pulmonary em...

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Sequence of reperfusion influences ischemia/reperfusion injury and primary graft function following porcine liver transplantation

et al. 2005

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The impact of 3 different reperfusion sequences following orthotopic liver transplantation (OLT) in pigs were evaluated. The reperfusion technique commonly performed is primary portal in order to shorten warm ischemic times (WITs). Experimental and clinical data, usually comparing 2 out of 3 possible reperfusion sequences, provide controversial results. OLT was performed in 24 pigs randomized into 3 groups: primary arterial (A), simultaneous (SIM), and primary portal (P) reperfusion. Hemodynamics were continuously monitored and reperfusion injury and primary graft function were assessed by standard serum parameters, histopathological findings, immunohistochemistry for heme oxygenase 1 (HO-1), and heat shock protein 70 (HSP 70). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and ␥-glutamyl transpeptidase (␥GT) following reperfusion were significantly increased for group A when compared to groups SIM and P. Hemodynamics showed significant differences after reperfusion compared to physiological data; differences in group comparisons were not significant. The bile production/100 g liver/hr was significantly higher for group SIM (1.15 mL) compared to group P (0.66 mL) and group A (0.62 mL). A lthough the first clinical liver transplantations were performed by arterial reperfusion before portal venous declamping, 1 the most common technique used is primary portal reperfusion. This sequence of reperfusion ought to minimize the warm ischemic time (WIT). This approach dates from an area when total ischemic time was limited to 8 hours of storage. With the implementation of University of Wisconsin and Bretschneider (histidinetryptophan-ketoglutarate [HTK]) solutions it became possible to prolong the cold storage beyond 20 hours. 2,3 Despite this and the more frequent use of marginal organs in solid organ transplantation, primary portal reperfusion in liver transplantation has yet not been altered, since most groups fear that a prolonged suturing time before reperfusion will cause a progressive rewarming and an increased injury of the liver graft, resulting in a higher incidence of primary nonfunction.

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Simultaneous arterial and portal revascularization in liver transplantation

Cited by 30 publications

References 10 publications

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

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

Randomized trial comparing pulmonary alterations after conventional with venovenous bypass versus piggyback liver transplantation

Sequence of reperfusion influences ischemia/reperfusion injury and primary graft function following porcine liver transplantation

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