Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.
Although liver transplantation (LT) outcomes have improved signi cantly over the last decades, early post-transplant vascular complications are still associated with an elevated risk of graft failure. Doppler ultrasound (DUS) enables detection of vascular complications and provides hepatic artery Resistive Index (RI). The aim of our study was to evaluate the association of the RI parameters of DUS performed in the rst post-transplant week with post-transplant outcomes. MethodsAll consecutive patients undergoing a rst LT between 2001 and 2019 at a single center were included. P were divided into three groups: RI < 0.55, RI 0.55-0.85 and RI > 0.85. Patients were also divided according to the presence or absence of hepatic artery thrombosis (HAT). Graft survival was compared among groups. ResultsThree hundred and forty-four patients were included. HAT occurred in 23 patients (6.7%), of which 7 were partial and 16 were complete. Biliary complications were more common in patients with HAT (11 [47.8%]) vs. 44 [13.4%] [p < 0.001]). There was no statistically signi cant difference in graft survival between patients with and without HAT. Patients with RI < 0.55 on post-operative day 1 had worse graft survival compared to patients with RI 0.55-0.85 and RI > 0.85. RI on post-operative day 3 and 5 was not predictive of graft survival. ConclusionsThe use of DUS on liver transplant recipients in the early post-transplant period offers the possibility of early diagnosis of vascular complications. Additionally, according to our data, low RI (< 0.55) on the rst postoperative day also provides prognostic information regarding graft-survival.
Purpose Although liver transplantation (LT) outcomes have improved significantly over the last decades, early post-transplant vascular complications are still associated with an elevated risk of graft failure. Doppler ultrasound (DUS) enables detection of vascular complications and provides hepatic artery Resistive Index (RI). The aim of our study was to evaluate the association of the RI parameters of DUS performed in the first post-transplant week with post-transplant outcomes. Methods All consecutive patients undergoing a first LT between 2001 and 2019 at a single center were included. P were divided into three groups: RI < 0.55, RI 0.55–0.85 and RI > 0.85. Patients were also divided according to the presence or absence of hepatic artery thrombosis (HAT). Graft survival was compared among groups. Results Three hundred and forty-four patients were included. HAT occurred in 23 patients (6.7%), of which 7 were partial and 16 were complete. Biliary complications were more common in patients with HAT (11 [47.8%]) vs. 44 [13.4%] [p < 0.001]). There was no statistically significant difference in graft survival between patients with and without HAT. Patients with RI < 0.55 on post-operative day 1 had worse graft survival compared to patients with RI 0.55–0.85 and RI > 0.85. RI on post-operative day 3 and 5 was not predictive of graft survival. Conclusions The use of DUS on liver transplant recipients in the early post-transplant period offers the possibility of early diagnosis of vascular complications. Additionally, according to our data, low RI (< 0.55) on the first postoperative day also provides prognostic information regarding graft-survival.
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