E166 Czigany Z, Scherer MN, Pratschke J, Guba M, Nadalin S, Mehrabi A, et al. Technical aspects of orthotopic liver transplantation-a survey-based study within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks. J Gastrointest Surg. 2018;23(3):529-37. https://doi.org/10.1007/s11605-018-3915-6
https://doi.org/10.1007/s11605-018-3915-...
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To investigate and reflect on the surgical aspects of orthotopic deceased donor liver transplantation performed in 52 transplant centers in Europe |
Was used an online survey instrument with multiple-choice questions that investigated the surgical aspects of liver transplantation and addressed the piggyback portocaval shunt, graft reperfusion techniques, and other factors. Five independent senior transplant surgeons initially tested content validity. |
The survey got feedback from 42 transplant centers. Of these, the most frequent reperfusion technique was portal vein reperfusion (PVFR: 64.3%, n=27/42), followed by simultaneous revascularization (SRI 17%, n=7/42), retrograde revascularization (RER 12 %, n=5/42) and arterial reperfusion first (AFR 7%, n=3/42). |
E255 Yang C, Huang L, Xinyu L, Zhu J, Leng X. Effects of retrograde reperfusion on the intraoperative internal environment and hemodynamics in classic orthotopic liver transplantation. BMC Surg. 2018;18:115. https://doi.org/10.1186/s12893-018-0441-0
https://doi.org/10.1186/s12893-018-0441-...
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To investigate the effects of retrograde reperfusion on the intraoperative internal environment and hemodynamics in classic orthotopic liver transplantation. |
After board approval and analysis, 30 subjects were included in the study according to the inclusion and exclusion criteria. Cadaver donor data were analyzed, standardized tests were performed, and graft harvesting was standardized. All 30 patients underwent orthotopic liver transplantation with non-venous bypass. In the procedure, retrograde revascularization is performed. |
All surgical procedures were successfully completed. Retrograde reperfusion employed in surgery has been shown to effectively reduce electrolyte disturbances and remove excess cytokines from the graft after recirculation in orthotopic liver transplants. Post-reperfusion syndrome in conventional liver transplants reaches 30%, while the incidence seen in this study was relatively low: 20% |
| E31010 Kniepeiss D, Iberer F, Grasser B, Schaffellner S, Stadlbauer V, Tscheliessnigg K-H. A single-center experience with retrograde reperfusion in liver transplantation. Transpl Int. 2003;16(10):730-5.
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To present a new method of reperfusion during liver transplantation. |
It is a retrospective study of four years before assessing hepatocyte integrity and AST values on days 1, 3, 5 and 8 after liver transplantation. The surgical technique was unclamping the vena cava after the piggyback anastomosis. |
Retrograde reperfusion efficiently removes perfusion fluid from the transplanted liver, eliminates toxic metabolites and agents, and improves the patient’s earlier recovery. Of the 39 patients, only one died due to preexisting portal vein thrombosis. After the eighth day, three of the 38 survivors had an indication for retransplantation due to hepatic artery thrombosis. |
E41111 Kniepeiss D, Zink M, Florian I, Schaffellner S, Jakoby E, Duller D, et al. Influence of retrograde flushing via the caval vein on the post-reperfusion syndrome in liver transplantation. Clin Transplant. 2004;18(6):638-41. https://doi.org/10.1111/j.1399-0012.2004.00231.x
https://doi.org/10.1111/j.1399-0012.2004...
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To evaluate the influence of retrograde reperfusion in liver transplantation in Post-Hepatic Reperfusion Syndrome (PHRS). |
Fifty-six consecutive liver transplants were performed using the piggyback technique with retrograde reperfusion via the vena cava. The incidence of post-reperfusion syndrome was assessed by intraoperative monitoring of mean arterial pressure through a pulmonary artery catheter. |
Fifty-three patients (94.34%) were alive on day eight after liver transplantation. Only two patients who underwent liver transplantation using the retrograde reperfusion technique had SPRH (3.6%) and a drop in blood pressure greater than 30%. |
E588 Heidenhain C, Heise M, Jonas S, Bem-Asseur M, Puhl G, Mittler J, et al. Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation – a randomized clinical trial. Transpl Int. 2006;19(9):738-48. https://doi.org/10.1111/j.1432-2277.2006.00347.x
https://doi.org/10.1111/j.1432-2277.2006...
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To investigate the influence of retrograde reperfusion in liver transplantation in reducing the initial risk of graft ischemia in contrast to the increased risk of ischemic biliary lesions |
132 patients undergoing orthotopic liver transplantation were included in the study and randomized into two groups. Group A underwent standard reperfusion: simultaneous arterial and portal anterograde. Group B underwent retrograde reperfusion via the vena cava before sequential anterograde reperfusion of the portal vein and hepatic artery. |
In the first week after the surgical procedure, the levels of transaminases and bilirubin in group B were significantly reduced. The incidence of ischemic-type biliary injury was 12.3% in group B versus 4.55% in group A, demonstrating that retrograde reperfusion seemed beneficial to hepatocytes but harmful to the biliary epithelium. |
E61212 Manzini G, Kremer M, Houben P, Gondan M, Bechstein WO, Becker T, et al. Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature. Transpl Int. 2013;26(5):508-16. https://doi.org/10.1111/tri.12083
https://doi.org/10.1111/tri.12083...
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To clarify which liver graft reperfusion technique leads to the best result after transplantation. |
An online survey was sent to 37 transplant centers, asking which reperfusion technique would be used and whether the procedure was standardized. Systematic literature search, study selection, data extraction and meta-analysis. |
Thirty transplant centers responded to the online questionnaire, and 28 were included in the study, showing that only three centers (11%) performed retrograde revascularization in transplants. |
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Source: Elaborated by the authors.
Source: Elaborated by the authors.
Source: Elaborated by the authors.
Source: Elaborated by the authors.
Source: Elaborated by the authors.
Source: Elaborated by the authors.