PMID- 31276282
OWN - NLM
STAT- MEDLINE
DCOM- 20200917
LR  - 20200917
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 25
IP  - 11
DP  - 2019 Nov
TI  - Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in 
      Orthotopic Liver Transplantation.
PG  - 1690-1699
LID - 10.1002/lt.25592 [doi]
AB  - 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.
CI  - Copyright (c) 2019 by the American Association for the Study of Liver Diseases.
FAU - Pietersen, Lars Cornelis
AU  - Pietersen LC
AD  - Division of Transplantation, Departments of Surgery, Leiden University Medical 
      Center, Leiden, the Netherlands.
FAU - Sarton, Elise
AU  - Sarton E
AD  - Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands.
FAU - Alwayn, Ian
AU  - Alwayn I
AD  - Division of Transplantation, Departments of Surgery, Leiden University Medical 
      Center, Leiden, the Netherlands.
FAU - Lam, Hwai-Ding
AU  - Lam HD
AD  - Division of Transplantation, Departments of Surgery, Leiden University Medical 
      Center, Leiden, the Netherlands.
FAU - Putter, Hein
AU  - Putter H
AD  - Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands.
FAU - van Hoek, Bart
AU  - van Hoek B
AD  - Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Braat, Andries Erik
AU  - Braat AE
AD  - Division of Transplantation, Departments of Surgery, Leiden University Medical 
      Center, Leiden, the Netherlands.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20190926
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
SB  - IM
MH  - Adult
MH  - Aged
MH  - Allografts/blood supply
MH  - Blood Loss, Surgical/*prevention & control/statistics & numerical data
MH  - Blood Transfusion/statistics & numerical data
MH  - End Stage Liver Disease/diagnosis/mortality/*surgery
MH  - Female
MH  - Graft Survival
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Liver/blood supply
MH  - Liver Transplantation/*adverse effects/methods
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Perioperative Period/statistics & numerical data
MH  - Portacaval Shunt, Surgical/adverse effects/*methods
MH  - Reperfusion/adverse effects/*methods
MH  - Reperfusion Injury/epidemiology/etiology/*prevention & control
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2019/07/06 06:00
MHDA- 2020/09/18 06:00
CRDT- 2019/07/06 06:00
PHST- 2018/12/28 00:00 [received]
PHST- 2019/06/06 00:00 [accepted]
PHST- 2019/07/06 06:00 [pubmed]
PHST- 2020/09/18 06:00 [medline]
PHST- 2019/07/06 06:00 [entrez]
AID - 10.1002/lt.25592 [doi]
PST - ppublish
SO  - Liver Transpl. 2019 Nov;25(11):1690-1699. doi: 10.1002/lt.25592. Epub 2019 Sep 
      26.