Poster 27. A temporary portocaval shunt and initial arterial perfusion in orthotopic liver transplantation

Thursday 14 march 2019

13:03 - 13:06h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 6 - Clinical

L.C. Pietersen1, E. Sarton2, I. Alwayn1, H.D. Lam3, H. Putter4, B. van Hoek5, A.E. Braat1

1Dept. of Surgery, Leiden University Medical Center,Leiden. 2Dept. of Anesthesiology, Leiden University Medical Center, Leiden.3Dept. of Surgery, Leiden University Medical Center, Leiden. 4Dept. of Medical Statistics, Leiden University Medical Center, Leiden. 5Dept. of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands.

Background: The use of a temporary portocaval shunt (TPCS), as well as the order of reperfusion (initial arterial reperfusion (IAR) vs. initial portal reperfusion (IPR)), in orthotopic liver transplantation (LT), is controversial, and therefore still under debate.

Methods: Aim of this study was to evaluate outcome for the four possible combinations (TPCS with IAR (A+S+), TPCS with IPR (A-S+), no-TPCS with IAR (A+S-), no-TPCS with IPR (A-S-)), in a center-based cohort study, including liver transplantations from both donation after brain death (DBD) and donation after circulatory death (DCD). Primary outcome was peroperative blood loss and secondary outcomes were operative time, incidence of non-anastomotic biliary strictures (NAS), patient- and graft survival. Between January 2005 and May 2017 all orthotopic, first liver transplantations performed in our institution were included into the four groups mentioned.

Results: The A+S+ group consisted of significant more DCD- LT (p=0.005). Since the introduction of A+S+, a significant decrease in peroperative transfusion of red blood cells (RBCs) was seen (p<0.001), as well as significant decrease in number of recipients who did not need any transfusion of RBCs (p<0.001). Multivariate analysis showed labMELD (p<0.001) and IAR (p=0.014) to be independent confounders on transfusion of RBCs. No statistical difference was seen in operative time, nor in 1-year incidence of NAS, 1-year patient- and graft survival, even though A+S+ consisted of significant more DCD-LT.

Conclusions: In conclusion, the introduction of TPCS and IAR in our clinic has led to significant less peroperative blood loss, without increasing operative time and seems to be a reasonable, alternative surgical strategy.