Rocuronium Profile During Orthotopic Liver Transplantation: Effect of Changing the Order of Vascular Clamp Release at Reperfusion of the Hepatic Graft

Sabaté, Antoni; Ferreres, E.; Valcárcel, Marta; Dalmau, A.; Koo, Maylin; Fabregat, Joan

doi:10.1016/j.transproceed.2010.02.072

Cited by 5 publications

(10 citation statements)

References 8 publications

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“…Several flushing techniques have been proposed, which include the following modalities: initial portal vein reperfusion , initial hepatic artery reperfusion , simultaneous reperfusion of portal vein and hepatic artery , retrograde reperfusion , and IVC venting , all with varying results .…”

Section: Discussionmentioning

confidence: 99%

“…Flushing out the retained hyperkalemic preservation solution and inflammatory mediators, which has been proved to be the most effect way of alleviating PRS, has been routinely utilized during the transplant procedure . Currently, several flushing methods for each caval anastomosis technique (conventional and piggyback) have been proposed (e.g., initial portal reperfusion , initial hepatic artery reperfusion , simultaneous reperfusion , retrograde reperfusion , IVC benting ) but the best way to alleviate PRS remains largely unknown .…”

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confidence: 99%

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Crystalloid flush with backward unclamping may decrease post‐reperfusion cardiac arrest and improve short‐term graft function when compared to portal blood flush with forward unclamping during liver transplantation

Fukazawa

Nishida

Hibi

et al. 2013

Clinical Transplantation

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During liver transplant (LT), the release of vasoactive substances into the systemic circulation is associated with severe hemodynamic instability that is injurious to the recipient and/or the post-ischemic graft. Crystalloid flush with backward unclamping (CB) and portal blood flush with forward unclamping (PF) are two reperfusion methods to reduce reperfusion-related cardiovascular perturbations in our center. The primary aim of this study was to compare these two methods. After institutional review board (IRB) approval, cadaveric whole LT cases performed between 2003 and 2008 were reviewed. Patients were divided into two groups based on reperfusion methods: CB or PF. After background matching with propensity score, the effect of each method on post-operative graft function was assessed in detail. In our cohort of 478 patients, CB was used in 313 grafts and PF in 165. Thirty-day graft survival was lower, and risk of retransplantation was higher in PF. Multivariable model showed that CB is an independent factor to reduce primary non-function, cardiac arrest and improve 30-d graft survival. Also, the incidence of ischemic-type biliary lesions was significantly higher in the PF group. Reperfusion methods affect intraoperative hemodynamics and post-transplant outcome. CB allows for control over temperature and composition of the perfusate, perfusion pressure, and the rate of infusion.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Crystalloid flush with backward unclamping may decrease post‐reperfusion cardiac arrest and improve short‐term graft function when compared to portal blood flush with forward unclamping during liver transplantation

Fukazawa

Nishida

Hibi

et al. 2013

Clinical Transplantation

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“…The prolongation of warm ischaemia time and the anhepatic phase with SIMR may impair the graft function [3]. In the systematic review of Gurusamy et al [11], only five randomized controlled trial were included [1,10,23,24,28]. The comparisons performed included IAR vs. IPR, SIMR vs. IPR and RETR vs. SIMR.…”

Section: Reviewsmentioning

confidence: 99%

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

et al. 2013

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SummaryIt remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, 508

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“…Therefore, potential advantages of the TPCS remain questionable, and its use is still debated. (9)(10)(11) Several older, small, prospective studies that were nonrandomized, randomized, and retrospective Pietersen et al Abbreviations: A+S+, temporary portocaval shunt with initial arterial reperfusion; A+S−, no temporary portocaval shunt with initial arterial reperfusion; A−S+, temporary portocaval shunt with initial portal reperfusion; A−S−, no temporary portocaval shunt with initial portal reperfusion; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BAR, balance of risk; BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after circulatory death; DRM, donor-recipient model; ET-DRI, Eurotransplant donor risk index; FFP, fresh frozen plasma; GGT, gamma-glutamyltransferase; IAR, initial arterial reperfusion; INR, international normalized ratio; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; NR, not reported; OLT, orthotopic liver transplantation; PTT, partial thromboplastin time; PV, portal Original article | 1691 investigated initial arterial reperfusion (IAR) (12)(13)(14)(15)(16)(17) and showed controversial results on outcomes after liver transplantation (LT). Thus, the ideal sequence of reperfusion is an issue that is still debated.…”

mentioning

confidence: 99%

“…Several older, small, prospective studies that were nonrandomized, randomized, and retrospective investigated initial arterial reperfusion (IAR) and showed controversial results on outcomes after liver transplantation (LT). Thus, the ideal sequence of reperfusion is an issue that is still debated.…”

mentioning

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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Rocuronium Profile During Orthotopic Liver Transplantation: Effect of Changing the Order of Vascular Clamp Release at Reperfusion of the Hepatic Graft

Cited by 5 publications

References 8 publications

Crystalloid flush with backward unclamping may decrease post‐reperfusion cardiac arrest and improve short‐term graft function when compared to portal blood flush with forward unclamping during liver transplantation

Crystalloid flush with backward unclamping may decrease post‐reperfusion cardiac arrest and improve short‐term graft function when compared to portal blood flush with forward unclamping during liver transplantation

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

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

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