Portocaval Shunt Throughout Anhepatic Phase in Orthotopic Liver Transplantation for Cirrhotic Patients

Cenarruzabeitia, Íñigo López de; Lázaro, José; Bilbao, Itxarone; Balsells, J.

doi:10.1016/j.transproceed.2007.07.045

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…Regarding the necessity of performing PCS, there is controversy among different authors 21. Through the use of caval‐preserving LTx techniques, using a temporary PCS has several advantages, including a decrease in the volume of the native liver, a reduction of the portal pressure leading to easier dissection and reduction of bleeding, better renal function, and the prevention of splanchnic congestion resulting in hemodynamic stability, specifically in the case of fulminant hepatitis 18, 21, 24, 44. The use of PCS in patients with cirrhosis who have high portal flow (>800‐1000 mL/minute) was also advocated by Figueras et al45 and Margarit et al46 In contrast, it has been reported that PCS is not necessary in cirrhotic livers with good collaterals of portosystemic shunts 18, 47.…”

Section: Discussionsupporting

confidence: 69%

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

2011

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Head and neck squamous cell carcinoma (HNSCC) is one of many cancers that are strongly associated with tobacco use. Whereas HNSCC is often seen in tobacco users, many tobacco users do not develop carcinoma; and the differences between smokers with and without HNSCC are poorly studied to date. Some smokers may be inherently more susceptible to developing carcinoma due to patterns of tobacco use, innate metabolism of carcinogens, or altered excretion. Identifying those smokers at greatest risk for HNSCC would have great benefit through targeted smoking cessation efforts and enhanced surveillance. One approach to better understand the extent of exposure to, and metabolism of, tobacco carcinogens is through the use of tobacco-specific metabolites. Tobacco-specific metabolites can identify patterns of dose, exposure, and metabolism, and perhaps ultimately characterize the important differences between smokers who develop HNSCC and smokers who do not.

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Section: Discussionsupporting

confidence: 69%

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

2011

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“…For creatinine on the third postoperative day, data from 4 studies [ 13 , 14 , 16 , 18 ] evaluated 785 patients with TPCS and 398 patients without TPCS. The mean difference was −0.19 [−0.48–0.10] ( Figure 14 ) and was not significantly different ( P =0.20).…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Surgical Portosystemic Shunt in Liver Transplantation: Systematic Review and Meta-Analysis

et al. 2018

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BackgroundExpanded clinical and surgical techniques in liver transplantation can markedly improve patient and graft survival. The main purpose of this study was to evaluate the efficacy of intraoperative portocaval shunts in liver transplantation.Material/MethodsSearches were conducted in Cochrane, MEDLINE, and EMBASE databases, and updated in January 2018. The following specific outcomes of interest were defined and evaluated separated using 2 different reviews and meta-analyses for 1) hemi-portocaval shunt (HPCS) and 2) temporary portocaval shunt (TPCS). Comparative studies were analyzed separately for both surgical portocaval shunt modalities.ResultsOnly 1 well-designed randomized controlled trial was found. Most studies were retrospective or prospective. Initially, we found 1479 articles. Of those selected, 853 were from PubMed/MEDLINE, 32 were from Cochrane and 594 were from EMBASE. Our meta-analysis included a total of 3232 patients for all the included studies. Results found that 41 patients with HPCS experienced increased 1-year patient survival (OR 16.33; P=0.02) and increased 1-year graft survival (OR 17.67; P=0.01). The TPCS analysis with 1633 patients found patients had significantly shorter intensive care unit length of stay (days) (P=0.006) and hospital length of stay (P=0.02) and had decreased primary nonfunction (PNF) (OR 0.30, P=0.02) and mortality rates (OR 0.52, P=0.01).ConclusionsIntraoperative surgical portosystemic shunt in relation to liver transplantation with TPCS was able to prevent PNF, decrease hospital length of stay and unit care length of stay. Furthermore, in analyzing data for patients with HPCS, we observed increases in the 1-year graft and patient survival rates. More prospective randomized trials are needed to arrive at a more precise conclusion.

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“…However, multivariate analysis showed only laboratory MELD and IAR to be individual determinants of perioperative transfusion of RBCs, whereas the interaction between IAR and TPCS was low ( P = 0.54). The beneficial effect of a TPCS, by using univariate analysis, has been described before (Table ) . These studies do not describe the order of reperfusion used during transplantation, although we assume that portal reperfusion was first.…”

Section: Discussionmentioning

confidence: 99%

“…The beneficial effect of a TPCS, by using univariate analysis, has been described before (Table 8). (7,(26)(27)(28) These studies do not describe the order of reperfusion used during transplantation, although we assume that portal reperfusion was first. A meta-analysis performed by Pratschke et al showed a significant beneficial effect of a TPCS on operative blood loss, but the I 2 values indicated substantial heterogeneity among the studies (P < 0.05), which could bring a potential bias to the results.…”

Section: Discussionmentioning

confidence: 99%

Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

et al. 2019

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The use of a temporary portocaval shunt (TPCS) as well as the order of reperfusion (initial arterial reperfusion [IAR] versus initial portal reperfusion) in orthotopic liver transplantation (OLT) is controversial and, therefore, still under debate. The aim of this study was to evaluate outcome for the 4 possible combinations (temporary portocaval shunt with initial arterial reperfusion [A+S+], temporary portocaval shunt with initial portal reperfusion, no temporary portocaval shunt with initial arterial reperfusion, and no temporary portocaval shunt with initial portal reperfusion) in a center‐based cohort study, including liver transplantations (LTs) from both donation after brain death and donation after circulatory death (DCD) donors. The primary outcome was the perioperative transfusion of red blood cells (RBCs), and the secondary outcomes were operative time and patient and graft survival. Between January 2005 and May 2017, all first OLTs performed in our institution were included in the 4 groups mentioned. With IAR and TPCS, a significantly lower perioperative transfusion of RBCs was seen (P < 0.001) as well as a higher number of recipients without any transfusion of RBCs (P < 0.001). A multivariate analysis showed laboratory Model for End‐Stage Liver Disease (MELD) score (P < 0.001) and IAR (P = 0.01) to be independent determinants of the transfusion of RBCs. When comparing all groups, no statistical difference was seen in operative time or in 1‐year patient and graft survival rates despite more LTs with a liver from a DCD donor in the A+S+ group (P = 0.005). In conclusion, next to a lower laboratory MELD score, the use of IAR leads to a significantly lower need for perioperative blood transfusion. There was no significant interaction between IAR and TPCS. Furthermore, the use of a TPCS and/or IAR does not lead to increased operative time and is therefore a reasonable alternative surgical strategy.

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Portocaval Shunt Throughout Anhepatic Phase in Orthotopic Liver Transplantation for Cirrhotic Patients

Cited by 13 publications

References 12 publications

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

Intraoperative Surgical Portosystemic Shunt in Liver Transplantation: Systematic Review and Meta-Analysis

Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

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