Effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors  

Abstract

Background The purpose of this study was to investigate effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors. Methods The clinical data of 136 patients who underwent liver transplantation at the 900th Hospital of the Chinese People's Liberation Army Joint Support Army from January 2015 to January 2021 were retrospectively analyzed. There were 115 males and 21 females; the age of these patients ranged from 20 to 70 years, with a median age of 51 years. All patients signed an informed consent, in accordance with medical ethics regulations. The patients were divided into retrograde reperfusion (RTR) group (n=108) and initial portal reperfusion (IPR) group (n=28) according to different liver perfusion methods during transplantation. After the two groups were matched by propensity score of 1:1, 23 patients in the two groups were compared in the recovery of liver function after operation.Within the cohort of 114 patients under scrutiny, rigorous exclusions were applied to the RTR group. Specifically, 8 cases presenting initial hepatic artery unveiling after retrograde reperfusion, and 14 cases with simultaneous hepatic artery and portal vein unveiling post RTR, were omitted. Consequently, the study's focal analysis encompassed 86 cases in the RTR subset and 28 cases within the IPR subset. The patients in RTR group (n=86) were further divided into EAD group (n=19) and non-EAD group (n=67) according to whether early hepatic allograft dysfunction (EAD) occurred after operation. The effects of preoperative and intraoperative parameters and liver perfusion methods on EAD after liver transplantation were analyzed. Results Alanine aminotransferase (ALT) was 329 (211~548) and 176 (98~282) U/L on the 3rd and 7th day after RTR, respectively, which was significantly lower than 451 (288~918) and 251 (147~430) U/L in the IPR group (Z =-1.979, -2.299, P= 0.048, 0.021). Aspartate aminotransferase (AST) on postoperative days 3, 5, and 7 was 252 (193, 522), 105 (79, 163), and 93 (41, 135) U/L in the RTR group, respectively; it was also significantly lower than 328 (251, 724), 179 (129, 306), and 150 (91, 200)U/L in the IPR group (Z=-2.212, -3.221, -2.979; P=0.027, 0.001, 0.003). Logistic regression analysis showed that MELD score was an independent risk factor for EAD after liver transplantation. Conclusion RTR liver transplantation is more favorable for patients' early postoperative liver function recovery. For patients undergoing liver transplantation for RTR, preoperative MELD score was an independent risk factor for their postoperative development of EAD.