Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature

Manzini, Giulia; Kremer, Michael; Houben, Philipp; Gondan, Matthias; Bechstein, Wolf O.; Becker, Thomas; Berlakovich, Gabriela; Friess, Helmut; Guba, Markus; Hohenberger, Werner; IJzermans, Jan N.M.; Jonas, Sven; Kalff, Jörg C.; Klar, E.; Klempnauer, Jürgen; Lerut, Jan; Lippert, H.; Lorf, Thomas; Nadalin, Silvio; Nashan, Björn; Otto, Gerd; Paul, Andreas; Pirenne, Jacques; Pratschke, Johann; Ringers, J.; Rogiers, Xavier; Schilling, Martin K.; Seehofer, Daniel; Senninger, N.; Settmacher, Utz; Stippel, Dirk L.; Tscheliessnigg, Karlheinz; Ysebaert, Dirk; Binder, H.; Schemmer, Peter

doi:10.1111/tri.12083

Cited by 30 publications

(24 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The most common technique used to reperfuse the liver involves initial reperfusion by portal blood followed by delayed arterial reperfusion . This has the theoretical advantage of minimizing the anhepatic period and warm ischemia time .…”

Section: Discussionmentioning

confidence: 99%

Postreperfusion microcirculatory derangements after liver transplantation: Relationship to hemodynamics, serum mediators, and outcome

et al. 2017

View full text Add to dashboard Cite

Despite the growing data supporting the role of microcirculation in regulating liver function, little of this knowledge has been translated into clinical practice. The aim of this study is to quantify hepatic microcirculation in vivo using sidestream dark field (SDF) imaging and correlate these findings with hepatic blood flow, hemodynamic parameters, and soluble mediators. Postreperfusion hepatic microcirculation was assessed using SDF imaging. Hepatic microcirculation measurements included functional sinusoidal density (cm/cm ), sinusoidal diameter (μm), red blood cell velocity (μm/second), volumetric blood flow (pl/second), and flow heterogeneity (FH) index. The serum concentrations of endothelin 1 (ET-1) and other inflammatory markers were analyzed with Luminex technology. Portal venous and hepatic artery flows were measured using a flowmeter. Twenty-eight patients undergoing cadaveric liver transplantations have been included in this study. Early allograft dysfunction (EAD) occurred in 7 (25%) patients and was associated with microcirculatory dysfunction. Low arterial and portal flow, high dose of inotropes, cold ischemia time, steatosis, and high ET-1 levels were all associated with impaired microcirculation. The time interval between portal venous and hepatic arterial reperfusion significantly correlated with the changes of the liver grafts' microcirculation. EAD patients tended to have higher serum levels of ET-1 on postoperative days 1, 2, 5, and 7 (all P < 0.01). Serum levels of ET-1 correlated significantly with microcirculation parameters. In conclusion, postreperfusion hepatic microcirculation is a determinant of organ dysfunction after liver reperfusion and could be used to identify very early patients at risk of EAD. Liver Transplantation 23 527-536 2017 AASLD.

show abstract

Section: Discussionmentioning

confidence: 99%

Postreperfusion microcirculatory derangements after liver transplantation: Relationship to hemodynamics, serum mediators, and outcome

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Previous investigators tested several techniques for graft reperfusion aiming to reduce the impact of graft preservative solution and ischemic products of the congested gut on the hemodynamics and graft function after portal unclamping. These techniques were tested in liver transplantation from deceased donors with no consensus on a preferred technique . In our exclusively LDLT program, we adopted graft extracorporeal rinse with patient's own portal blood as a default practice for 6 years.…”

Section: Introductionmentioning

confidence: 99%

Short-term effects of extracorporeal graft rinse versus circulatory graft rinse in living donor liver transplantation. A prospective randomized controlled trial

et al. 2017

View full text Add to dashboard Cite

Living donor liver transplantation has shorter cold ischemia time, less preservative volume, and lower metabolic load compared to transplantation from deceased donors. We investigated the impact of rinsing the graft contents into the systemic circulation on operative course and postoperative outcomes. Donors had right hepatectomy, and grafts were preserved with cold histidine-tryptophan-ketoglutarate solution. On ending portal vein anastomosis, grafts were flushed by patient's portal blood either through incompletely anastomosed hepatic vein (extracorporeal rinse group, EcRg, n = 40) or into systemic circulation (circulatory rinse group, CRg, n = 40). The primary outcome objective was the lowest mean arterial blood pressure within 5 min after portal unclamping as a marker for postreperfusion syndrome (PRS). Secondary objectives included hemodynamics and early graft's and patient's outcomes. Within 5 min postreperfusion, mean arterial blood pressure was significantly lower in the CRg compared to the EcRg, yet this was clinically insignificant. Postoperative graft functions, early biliary and vascular complications, and three-month survival were comparable in both groups. Rinsing the graft into the circulation increased the incidence of PRS without significant impact on early graft or patient outcome in relatively healthy recipients.

show abstract

“…The analysis of the data was carried out in a descriptive fashion. The online survey on graft rinse protocols was carried out in addition to a survey about the sequence of reperfusion in LT, the results of which have been previously reported .…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2015

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature

Cited by 30 publications

References 37 publications

Postreperfusion microcirculatory derangements after liver transplantation: Relationship to hemodynamics, serum mediators, and outcome

Postreperfusion microcirculatory derangements after liver transplantation: Relationship to hemodynamics, serum mediators, and outcome

Short-term effects of extracorporeal graft rinse versus circulatory graft rinse in living donor liver transplantation. A prospective randomized controlled trial

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

Contact Info

Product

Resources

About