Application of various surgical techniques in liver transplantation: a retrospective study

Chen, Zhitao; Wang, Ju; Chen, Chuanbao; Wang, Tielong; Yu, Jia; Hong, Xitao; Dong, Yuqi; Chen, Maogen; He, Xiaoshun

doi:10.21037/atm-21-1945

Cited by 4 publications

(2 citation statements)

References 42 publications

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“…Historically, OLT had been characterized by high blood loss and aggressive product‐based resuscitation; however, the resuscitative strategy has gradually shifted towards a more restrictive approach, which has been associated with improved recipient outcomes 2–6 . This paradigm, coupled with advancements in operative technique and graft preservation, has yielded an overall reduction in product utilization among OLT recipients, though the potential for massive intraoperative transfusion still exists 7–10 . The disparate range of blood product utilization in liver transplantation creates a logistical dilemma for operative and blood bank teams, characterized by an elusive balance between under‐preparation leading to delayed intraoperative resuscitation, and overpreparation risking waste of perishable blood products such as platelets (Plts).…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 , 4 , 5 , 6 This paradigm, coupled with advancements in operative technique and graft preservation, has yielded an overall reduction in product utilization among OLT recipients, though the potential for massive intraoperative transfusion still exists. 7 , 8 , 9 , 10 The disparate range of blood product utilization in liver transplantation creates a logistical dilemma for operative and blood bank teams, characterized by an elusive balance between under‐preparation leading to delayed intraoperative resuscitation, and overpreparation risking waste of perishable blood products such as platelets (Plts). Together, these conflicting priorities underscore the need for effective and applicable models to predict intraoperative transfusion requirements during OLT despite the complexities of end‐stage liver disease and liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship

et al. 2022

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Background Unanticipated transfusion requirements during liver transplantation can delay lifesaving intraoperative resuscitation and strain blood bank resources. Risk‐stratified preoperative blood preparation can mitigate these deleterious outcomes. Study Design and Methods A two‐tiered blood preparation protocol for liver transplantation was retrospectively evaluated. Eleven binary variables served as criteria for high‐risk (HR) allocation. Primary outcomes included red blood cell (RBC), plasma (FFP), and platelet (Plt) utilization. Secondary outcomes included product under‐ and overpreparation. Contingency tables for transfusion requirements above the population means were generated using 15 clinical variables. Modified protocols were developed and retrospectively optimized using the study population. Results Of 225 recipients, 102 received HR preoperative orders, which correlated to higher intraoperative transfusion requirements. However, univariate analysis identified only two statistical risk factors per product: Hgb ≤7.8 g/dl (p < .001) and MELD ≥38 (p = .035) for RBCs, Hgb ≤7.8 g/dl (p = .002) and acute alcoholic hepatitis (p = 0.015) for FFP, and Hgb ≤7.8 g/dl (p = .001) and normothermic liver preservation (p = .037) for Plts. Based on these findings, we developed modified protocols for individual products, which were evaluated retrospectively for their effectiveness at reducing under‐preparatory events while limiting product overpreparation. Cohort statistics were used to define the preparation strategy for each protocol. Retrospective comparative analysis demonstrated the superiority of the modified protocols by improving the under‐preparation rate from 24% to <10% for each product, which required a 1.56‐fold and 1.44‐fold increase in RBC and FFP overpreparation, respectively. Importantly, there was no difference in Plt overpreparation. Discussion We report translatable data‐driven blood bank preparation protocols for liver transplantation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship

et al. 2022

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Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis

Khajeh¹,

Ramouz²,

Aminizadeh³

et al. 2023

HPB

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Modified cavocavostomy technique for deceased donor liver transplantation

Voskanyan

Artemiev

Сушков

et al. 2022

Transplantologiâ (Mosk.)

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Rationale. The refinement of liver transplantation technique, the development and implementation of new surgical technologies into clinical practice, including those for inferior vena cava reconstruction, are important for the improvement of surgery outcomes.The study purposes were to present our own modification of cavocavostomy and options for its technical implementation in deceased donor liver transplantation, as well as to study the clinical effects and the impact of new surgical technique on the outcomes.Material and methods. A retrospective, single-centre study included the data from 109 consecutive deceased donor liver transplantations performed between 2012 and 2021. In 106 procedures, inferior vena cava reconstruction was performed either according to the classic technique (group 1, n=23, 22%), or using our own modification of cavocavostomy (group 2, n=83, 78%). To assess the clinical efficacy and safety of the new surgical technique, we compared the characteristics of donors and recipients, intraoperative parameters, features of early postoperative course, incidence of surgical complications, initial function, immediate and long-term graft survival. Three piggyback procedures were not included in the comparative analysis.Results. Two groups were generally comparable in terms of the characteristics of donors and recipients, however, the classic inferior vena cava was significantly more often used during transplants for unresectable parasitic liver lesions (17% vs. 1%, p=0.008) and retransplantations (30% vs. 5%, p=0.002). There were no statistically significant differences in the main intraoperative parameters between groups 1 and 2. The duration of transplantations was 8.0 h (interquartile range: 6.5–8.5 h) and 7.0 h (interquartile range: 6.0–8.0 h), p=0.112; anhepatic phase lasted 70 min (interquartile range: 60–75 min) and 70 min (interquartile range: 59–90 min), p=0.386; warm ischemia time was 45 min (interquartile range: 38–52 min) and 45 min (interquartile range: 38–50 min), p=0.690; inferior vena cava was clamped for 47 min (interquartile range: 40–55 min) and 50 min (interquartile range: 40–55 min), p=0.532. The volumes of intraoperatively transfused blood components were, respectively: packed red cells 630 ml (interquartile range: 0–1280 ml) and 600 ml (interquartile range: 0–910 ml), p=0.262; blood reinfusion 770 ml (interquartile range: 360–1200 ml) and 700 ml (interquartile range: 0–1200 ml), p=0.370; fresh frozen plasma 2670 ml (interquartile range: 2200 and 3200 ml) and 2240 ml (interquartile range: 1880–2900 ml), p=0.087.When using classic caval reconstruction technique, the proportion of grafts with early dysfunction was higher: 44% vs. 17% (p=0.011), due to the higher rate of retransplantations in this group. The incidence of acute kidney injury (by RIFLE > I) was 35% and 19% (p=0.158), the need for renal replacement therapy was 22% and 15% (p=0.520) in group 1 and group 2, respectively. The total incidence of surgical complications in the early postoperative period was 30% and 16%, p=0.110.Conclusions. The proposed technique of cavocavostomy can be considered as a priority method for caval reconstruction during deceased donor liver transplantation, with the exception of specific indications for the use of the classic technique (retransplantation, involvement of the inferior vena cava wall in a parasitic process or presentation of a tumor node to it, as well as in cases of widespread adhesive process in the abdominal cavity, hypertrophy of the 1 segment of the native liver, the presence and location of TIPS, thinning of the wall of the retrohepatic inferior vena cava, the risk of graft compression with its large size).The choice of the cavocavostomy variant should be carried out taking into account the size ratio of the graft to the recipient's right subdiaphragmatic space, and the topography features of the recipient's hepatic veins.

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Application of various surgical techniques in liver transplantation: a retrospective study

Cited by 4 publications

References 42 publications

Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship

Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship

Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis

Modified cavocavostomy technique for deceased donor liver transplantation

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