Objectives of this study are to quantify the need for blood transfusion during liver transplantation (LT) and confirm the importance of intraoperative blood transfusion as an independent prognostic factor for postoperative outcome. Furthermore, we try to detect useful variables for the preoperative identification of patients likely to require transfusion of packed red blood cell units (PRCUs) and identify measures to reduce transfusion needs. Data were collected prospectively between September 1998 and November 2000. One hundred twenty-two LTs were included in the study. Forty-two patients (34%) did not require transfusion of PRCUs. In multivariate analysis, transfusion of more than three PRCUs was found to be the only significant variable associated with prolonged hospital stay. In addition, excluding perioperative deaths, PRCU transfusion, using a cutoff value of six units, was the only variable to reach statistical significance (P ‫؍‬ .008; risk ratio, 4.93; 95% confidence interval, 15 to 15.9) to predict survival in a multivariate analysis that also included Child's class and United Network for Organ Sharing (UNOS) classification. Moreover, only preoperative hemoglobin (Hb) level was found to significantly predict the need for transfusion of one or more PCRUs. Finally, only UNOS classification and placement of an intraoperative portacaval shunt were found to be statistically significant to predict the need to transfuse more than six PRCUs. We found the requirement of even a moderate number of blood transfusions is associated with longer hospital stay, and transfusion of more than six PRCUs is associated with diminished survival. Preoperative normalization of Hb levels and placement of an intraoperative portacaval shunt can diminish the number of blood transfusions during LT. (Liver Transpl 2003;9:1320-1327.)

No abstract

The results were incorporated into a decision matrix, creating a computer program (OncoSurge). This model identifies individual patient resectability, recommending optimal treatment strategies. It may also be used for medical education.

This study aims to determine whether the use of a temporary portocaval shunt (PCS) improves hemodynamic and metabolic evolution during orthotopic liver transplantation (OLT). Preservation of the vena cava during OLT has gained wide acceptance. However, benefits of adding a temporary PCS to the piggyback technique during the anhepatic phase in patients with cirrhosis have not been shown. Eighty patients with cirrhosis were studied prospectively. They were randomly distributed into two groups: patients with a temporary PCS (n ‫؍‬ 40) and those without a PCS (n ‫؍‬ 40). In all cases, the piggyback technique was used. Hemodynamic profiles and biochemical data during OLT and clinical evolution after OLT were evaluated. Preoperative data were similar in both groups. Surgical time also was similar (403 ؎ 77 v 387 ؎ 56 minutes; P ‫؍‬ .3). Red blood cell requirements were lower in the PCS group (2.3 ؎ 2.5 v 3.3 ؎ 2.9 units), although differences were not significant. In the PCS group, 45% of patients did not need red blood cell transfusion, whereas in the other group, only 22% were not administered a transfusion (P ‫؍‬ .03). During the anhepatic phase, the decrease in cardiac output was lower in the PCS group (-9.6% v -19%; P ‫؍‬ .05), whereas diuresis during the anhepatic phase was greater in the PCS group (3.6 ؎ 2.97 v 2.1 ؎ 1.38 mL/kg/h; P ‫؍‬ .005). There were no differences in liver biochemical parameters during the first 3 postoperative days. Nevertheless, creatinine levels increased significantly during this period only in the no-PCS group. The use of a temporary PCS during OLT improves hemodynamic status, reduces intraoperative transfusion requirements, and preserves renal function during and after OLT. T he classic surgical technique for orthotopic liver transplantation (OLT) involves recipient hepatectomy with resection of the retrohepatic vena cava and cross-clamping of the portal vein. 1 Interruption of caval flow during the anhepatic phase results in a reduction in venous return to the heart 2 and a decrease in renal perfusion, 3 as well as splanchnic hyperemia secondary to portal clamping. Venovenous bypass improves hemodynamic stability and allows decompression of the occluded splanchnic venous system. 4 However, the use of venous bypass is associated with other complications, such as hypothermia and pulmonary thromboembolism. 5,6 In 1968, Calne and Williams 7 described preservation of the vena cava. This technique, known as piggyback, 8 was further developed in pediatric OLT, 9 but has gained wide acceptance in adults, mainly in Europe. [10][11][12][13] Nevertheless, it does not avoid splanchnic hyperemia secondary to portal clamping.The use of a temporary portocaval shunt (PCS) with the piggyback technique was first described by Tzakis et al,14 then by Belghiti at al. 15 Previous studies have shown that preservation of both portal and caval blood flows throughout the procedure maintains hemodynamic stability and renal perfusion pressure. [16][17][18][19] This technique is particularly useful for patient...

Orthotopic liver transplantation (OLT) offers the only chance to eliminate both tumor and liver disease in patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumor progression while on the waiting list and recurrence after OLT are frequent. We undertook a large multicenter study to assess survival and related factors of recurrence after OLT. This retrospective study analyses data from 307 consecutive patients with HCC and cirrhosis treated with OLT between 1990 and 1997 in eight centers in Spain. OLT was indicated only for small (<5 cm) localized tumors. Five-year rates after OLT were 63% for survival, 58% for disease-free survival, and 21% for recurrence. Tumor diameter larger than 5 cm was associated with other tumor characteristics that were significant indicators of poor outcome (absence of capsule, three or more nodules, bilobularity, satellite nodules, and vascular invasion). However, in multivariate analysis, alpha fetoprotein (AFP) levels greater than 300 ng/mL (P ‫؍‬ .04; P ‫؍‬ .02) and macroscopic vascular invasion (P ‫؍‬ .01; P ‫؍‬ .0001) were the only factors independently associated with mortality and recurrence, respectively. OLT is indicated in patients with small HCCs who have low AFP levels and no macroscopic vascular invasion or extrahepatic disease. By increasing our ability for preoperative tumor imaging, we will achieve better selection of patients with HCC before OLT. (Liver Transpl 2001;7: 877-883.) H epatocellular carcinoma (HCC) is the most common primary hepatic malignancy, 1 and in most cases, it develops in association with liver cirrhosis. Surgical removal, either by partial hepatic resection or orthotopic liver transplantation (OLT), offers the only chance for long-term cure. Results of HCC resection in cirrhotic patients have been disappointing, mainly because of postoperative liver decompensation and, subsequently, the high rate of intrahepatic recurrence. 2 OLT has the theoretical advantage of eliminating both the tumor and liver disease. In comparison to liver resection, recurrence after OLT in patients with selected HCC is low. 3,4 However, the waiting list for OLT is increasing because of the organ shortage, and tumor growth during this time may lead to exclusion criteria for OLT. Adult living donor transplantation is emerging as a new therapeutic option to overcome this problem. Consequently, the ability to determine the relative risk for recurrence of HCC after OLT would allow a more equitable allocation of a scarce resource. However, selection criteria before OLT are not agreed on and may vary among centers.Because data about risk factors of survival and recurrence from single-center studies are insufficient, we undertook a large multicenter study to assess selection criteria and related factors in patients with cirrhosis and HCC treated by OLT. Patients and MethodsThis retrospective study was performed between January 1990 and December 2000 in eight centers in Spain. Data from 388 consecutive patients with HCC and cirrhosis treated with OLT were collected...

Portal thrombosis is associated with greater operative complexity and rethrombosis, but has no influence on overall morbidity and mortality.

This study provides some evidence that postoperative chemotherapy is beneficial; however, prospective randomized studies are necessary to define its exact role.

Helical CT is a noninvasive, reliable, and accurate technique for imaging the liver and should be considered as the standard preoperative work-up of hepatic metastases from colorectal cancer.