Obviation of Prereperfusion Rinsing and Decrease in Preservation/Reperfusion Injury in Liver Transplantation by Portal Blood Flushing1

Emre, Sükrü; Schwartz, Myron; Mor, Eytan; Kishikawa, Keiji; Yağmur, Özgür; Thiese, Neil; Sheiner, Patricia A.; Jindal, Rahul M.; Chiodini, S.; Miller, Charles M.

doi:10.1097/00007890-199403270-00004

Cited by 33 publications

(15 citation statements)

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“…One experimental study showed that the major part of reperfusion injury is constituted during the portal venous reperfusion and that this injury can be, at least partially, attenuated by initial arterial reperfusion [51]. Other authors tested a prereperfusion with either dextrose 5% or Ringer's lactate solution prior to reperfusion, but could not show a significant benefit [52,53]. Simultaneous reperfusion is the standard procedure in our institution.…”

Section: Discussionmentioning

confidence: 99%

Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation – a randomized clinical trial

et al. 2006

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Summary Initial nonfunction (INF) and biliary complications such as ischemic‐type biliary lesion (ITBL) remain two major complications in clinical orthotopic liver transplantation (OLT). The influence of ischemia and reperfusion injury (I/R) as a significant risk factor for both complications is widely unquestioned. A new reperfusion technique that reduces I/R injury should lead to a reduction in both INF and ITBL. One hundred and thirty two OLT patients were included in this study and randomized into two groups. Group A underwent standard reperfusion with anterograde simultaneous arterial and portal reperfusion and group B received retrograde reperfusion via the vena cava before sequential anterograde reperfusion of portal vein and hepatic artery. Serum transaminase level as a surrogate parameter for I/R injury and serum bilirubin level as a parameter for graft function were significantly reduced during the first week after OLT in group B. INF rate was 7.7% in group A and 0% in group B (P = 0.058). ITBL incidence was 4.55% in group A versus 12.3% in group B (P = 0.053). Retrograde reperfusion seemed to be beneficial for hepatocytes, but was detrimental for the biliary epithelium. The unexplained increased incidence of ITBL after retrograde reperfusion will be focus of further investigation.

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Section: Discussionmentioning

confidence: 99%

Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation – a randomized clinical trial

et al. 2006

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“…The endpoints evaluated in most reports could be summarized in three main categories. In the first category, laboratory parameters were tested, in which case transaminases and bilirubin were usually used to determine differences in graft damage and function . According to the potential benefit of various graft rinse protocols in preventing PRS, hemodynamic parameters were classified as the second common category , and the third category focused on graft function and survival data .…”

Section: Discussionmentioning

confidence: 99%

“…In 1994, Emre postulated an advantage of portal blood rinse over graft rinse with lactated Ringer's solution with regard to the incidence of poor early graft function . In this retrospective work, four modes of graft rinse with lactated Ringer's solution and/or portal blood were studied.…”

Section: Discussionmentioning

confidence: 99%

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

et al. 2015

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SummaryGraft rinse prior reperfusion in liver transplantation (LT) is believed to reduce the incidence of postreperfusion syndrome and improve clinical outcome. A MEDLINE search was performed to obtain a comprehensive review of the published literature dealing with graft rinse in LT. Moreover, all thirty-four LT centers in the Eurotransplant (ET) region were invited to participate in an online survey to whether or not graft rinse is performed and whether further research in the field is needed. Seventeen reports have been found to investigate graft rinse protocols in 1894 LT recipients. Eighteen of the thirty centers that participated in the online survey performed graft rinse prior reperfusion in LT. The most commonly used rinse solution was albumin. Nineteen centers stated interest in participating in a multicenter RCT in the field. The published literature does not provide concluding appraisal of the benefit of graft rinse in LT. Graft rinse protocols are not standardized and are based on personal experience. Appropriately designed clinical trials addressing the topic are demanded. The online survey appears to be a helpful tool for the evaluation of clinical practice and future research topics in the transplant community.

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“…The first portion of blood (up to 500 ml) is discarded via an opening in the infrahepatic IVC before the caval clamps are released. With this sequence of clamp release, post‐reperfusion syndrome will be a rare event (3, 5).…”

Section: Anhepatic Phasementioning

confidence: 99%

Surgical Techniques of Adult Liver Transplantation

Bechstein

2001

European Surg

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Summary: Background: Adult liver transplantation remains a challenging procedure which promises cure for a variety hepatic diseases.  Methods: The technique of adult liver transplantation is reviewed.  Results: Donor hepatectomy has to assure organ procurement with respect to anatomical variations including blood supply to organ‐transplantable organs, careful handling to avoid additional damage and interdisciplinary communication regarding timing and coordination of abdominal and thoracic perfusion. The transplantation itself is characterised by three different phases. Dissection leading to recipient hepatectomy may be rendered difficult not only by portal hypertension but also by previous upper abdominal surgery. The anhepatic phase elicits specific pathophysiology regarding circulation and hemostasis and requires meticulous suturing of vascular anastomosis. Finally, after reperfusion and hemostasis, anastomoses for biliary drainage are performed. The most common early surgical complications are briefly described. In this review, special emphasis is placed on personal experience and fine points of surgical technique.  Conclusions: Correct surgical techniques are a prerequisite for immediate and optimal graft function and patient survival.

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Obviation of Prereperfusion Rinsing and Decrease in Preservation/Reperfusion Injury in Liver Transplantation by Portal Blood Flushing1

Cited by 33 publications

References 0 publications

Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation – a randomized clinical trial

Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation – a randomized clinical trial

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

Surgical Techniques of Adult Liver Transplantation

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