Intraoperative Portal Vein Flow &gt; 123 mL/min Per 100 g Predicts a Better Survival of Patients After Liver Transplantation

Marambio, Andrés; Tuñón, Juan M. Castillo; Gómez, Luis Miguel Marín; Martínez, J. M. Álamo; Bellido, C. Bernal; Artacho, G. Suárez; Franco, Carmen Cepeda; Barrera-Pulido, L.; Ruiz, Francisco Javier Padillo; Bravo, Miguel Ángel Gómez

doi:10.1016/j.transproceed.2018.06.032

Cited by 7 publications

(11 citation statements)

References 22 publications

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“…The prognostic relevance of PV flow on graft outcomes has been the focus of several prior studies albeit comprising cohorts of predominantly brain-dead liver allografts. These reports determined various portal flow thresholds ranging from 65 to 120 mL/minute/100 g, (10,11,18) or in other instances absolute values of >1 L/minute, (9) as being predictive of graft survival. Recent data from Original article | 71 our institution in a large cohort of mostly brain-dead, whole-liver allografts revealed a bimodal distribution of portal flow toward predicting early graft loss at thresholds of <65 mL/minute/100 g and >155 mL/ minute/100 g, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of EAD was not significantly associated with the duration of WIT or CIT in our cohort. When analyzing the incidence of this phenomenon against flow rates, no significant associations were distinguishable for PV flow (EAD versus no EAD: median [interquartile range, IQR]), 97 [67-130] versus 94 [72-141] mL/minute/100 g; P = 0.55) and HA flow (EAD versus no EAD: median [IQR], 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] versus 16 [11][12][13][14][15][16][17][18][19][20][21][22][23][24] mL/minute/100 g; P = 0.64). Interestingly, BC approached but did not attain statistical significance (EAD versus no EAD: median [IQR], 0.05 [0.01-0.11] versus 0.02 [0-0.07]; P = 0.05).…”

Section: Early Allograft Dysfunctionmentioning

confidence: 99%

“…(7,8) Although a committal to the graft-recipient pairing has occurred by the time of reperfusion, the prognostic assessment of the liver graft still continues beyond this period. The measurement of vascular inflow rates into the new liver has been demonstrated as a valuable tool in providing prognostic data for allograft outcomes (9)(10)(11) whilst informing surgeons on the value of instituting potentially corrective intraoperative measures (such as splenic artery or portosystemic shunt ligation) that can help modulate hepatic inflow further and maintain optimal graft perfusion. (12) The majority of existing literature in this regard however pertains to hybrid cohorts that comprise mostly brain-dead donors, and as such these inflow thresholds are currently unknown within the realm of DCD liver transplantation.…”

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confidence: 99%

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The Prognostic Utility of Intraoperative Allograft Vascular Inflow Measurements in Donation After Circulatory Death Liver Transplantation

et al. 2021

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Donation after circulatory death (DCD) liver transplantation improves deceased donor liver use and decreases waitlist burden, albeit at an increased risk of biliary complications and inferior graft survival. Employing liver vascular inflow measurements intraoperatively permits allograft prognostication. However, its use in DCD liver transplantation is hitherto largely unknown and further explored here. DCD liver transplantation patient records at a single center from 2005 to 2018 were retrospectively scrutinized. Intraoperative flow data and relevant donor parameters were analyzed against endpoints of biliary events and graft survival. A total of 138 cases were chosen. The incidence of cumulative biliary complications was 38%, the majority of which were anastomotic strictures and managed successfully by endoscopic means. The ischemic cholangiopathy rate was 6%. At median thresholds of a portal vein (PV) flow rate of <92 mL/minute/100 g and buffer capacity (BC) of >0.04, both variables were independently associated with risk of biliary events (P = 0.01 and 0.04, respectively). Graft survival was 90% at 12 months and 75% at 5 years. Cox regression analysis revealed a PV flow rate of <50 mL/minute/100 g as predictive of poorer graft survival (P = 0.01). Furthermore, 126 of these DCD livers were analyzed against a propensity-matched group of 378 contemporaneous donation after brain death liver allografts (1:3), revealing significantly higher rates (P < 0.001) of both early allograft dysfunction (70% versus 30%) and biliary complications (37% versus 20%) in the former group. Although flow data were comparable between both sets, PV flow and BC were predictive of biliary events only in the DCD cohort. Intraoperative inflow measurements therefore provide valuable prognostication on biliary/graft outcomes in DCD liver transplantation, can help inform graft surveillance, and its routine use is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Early Allograft Dysfunctionmentioning

confidence: 99%

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confidence: 99%

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The Prognostic Utility of Intraoperative Allograft Vascular Inflow Measurements in Donation After Circulatory Death Liver Transplantation

et al. 2021

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“…However, a similar study comparing effects of propofol on sevoflurane on hepatic graft survival yielded no different effects between both anesthetic agents [ 26 ]. Maintaining adequate HBF is important for allograft [ 2 – 4 ] and patient survival [ 5 , 6 ]. Yet, potential effects of anesthetic agents on HBF in the clinical setting remain largely unexplored.…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining adequate perioperative hepatic blood flow supply is essential for preservation of postoperative normal liver function, especially during major hepatic surgery [ 1 ] and liver transplantation for both graft [ 2 – 4 ] and patient [ 5 , 6 ] survival. HBF is unique because it receives a dual blood flow from both the hepatic artery and the portal vein [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial

et al. 2020

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Background Maintaining adequate perioperative hepatic blood flow (HBF) supply is essential for preservation of postoperative normal liver function. Propofol and sevoflurane affect arterial and portal HBF. Previous studies have suggested that propofol increases total HBF, primarily by increasing portal HBF, while sevoflurane has only minimal effect on total HBF. Primary objective was to compare the effect of propofol (group P) and sevoflurane (group S) on arterial, portal and total HBF and on the caval and portal vein pressure during major abdominal surgery. The study was performed in patients undergoing pancreaticoduodenectomy because - in contrast to hepatic surgical procedures - this is a standardized surgical procedure without potential anticipated severe hemodynamic disturbances, and it allows direct access to the hepatic blood vessels. Methods Patients were randomized according to the type of anesthetic drug used. For both groups, Bispectral Index (BIS) monitoring was used to monitor depth of anesthesia. All patients received goal-directed hemodynamic therapy (GDHT) guided by the transpulmonary thermodilution technique. Hemodynamic data were measured, recorded and guided by Pulsioflex™. Arterial, portal and total HBF were measured directly, using ultrasound transit time flow measurements (TTFM) and were related to hemodynamic variables. Results Eighteen patients were included. There was no significant difference between groups in arterial, portal and total HBF. As a result of the GDHT, pre-set hemodynamic targets were obtained in both groups, but MAP was significantly lower in group S (p = 0.01). In order to obtain these pre-set hemodynamic targets, group S necessitated a significantly higher need for vasopressor support (p < 0.01). Conclusion Hepatic blood flow was similar under a propofol-based and a sevoflurane-based anesthetic regimen. Related to the application of GDHT, pre-set hemodynamic goals were maintained in both groups, but sevoflurane-anaesthetized patients had a significantly higher need for vasopressor support. Trial registration Study protocol number is AGO/2017/002 – EC/2017/0164. EudraCT number is 2017–000071-90.Clin.trail.gov,NCT03772106, Registered 4/12/2018, retrospective registered.

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Effective Technique for Pancreas Transplantation by Iliac Vascular Transposition, Without Heparin‐Based Anticoagulation Therapy

et al. 2021

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Background To evaluate patients undergoing a new procedure, iliac vascular transposition, in pancreas transplantation regarding the risk of thrombosis and graft survival without heparin-based anticoagulation therapy. Methods Iliac vascular transposition (IVT) involves changing the positions of the external iliac artery and vein relative to each other. In this study, this technique was evaluated in patients undergoing the procedure compared with patients not undergoing the procedure (iliac vascular parallel (IVP) group).Results No patients received prophylactic heparin therapy. Two patients in the IVP group (n = 26) developed complete thrombosis and six developed partial thrombosis, compared with no patients with complete thrombosis and one with partial thrombosis in the IVT group (n = 29). The cumulative incidence of thrombosis was significantly higher in the IVP group (p \ 0.01). Cox regression revealed that not receiving iliac vascular transposition was the only significant risk factor for thrombosis (odds ratio: 10.1, 95% confidence interval: 1.27-81.2; p = 0.03). One-year graft survival was significantly better in the IVT group vs IVP group (p = 0.03). Conclusions IVT in pancreas transplantation is a simple technique that results in a lower thrombosis risk and better graft survival rates without heparin-based anticoagulation therapy.

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Intraoperative Portal Vein Flow > 123 mL/min Per 100 g Predicts a Better Survival of Patients After Liver Transplantation

Cited by 7 publications

References 22 publications

The Prognostic Utility of Intraoperative Allograft Vascular Inflow Measurements in Donation After Circulatory Death Liver Transplantation

The Prognostic Utility of Intraoperative Allograft Vascular Inflow Measurements in Donation After Circulatory Death Liver Transplantation

Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial

Effective Technique for Pancreas Transplantation by Iliac Vascular Transposition, Without Heparin‐Based Anticoagulation Therapy

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