Temporary Intraoperative Porto‐Caval Shunts in Piggy‐Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta‐Analysis

Pratschke, Sebastian; Rauch, Alexandra; Albertsmeier, Markus; Rentsch, Markus; Kirschneck, Michaela; Andrassy, Joachim; Thomas, Michael; Hartwig, Werner; Figueras, Joan; Marti, Josep; Ruvo, N. De; Werner, Jens; Guba, Markus; Weniger, Maximilian; Angele, Martin K.

doi:10.1007/s00268-016-3656-1

Cited by 28 publications

(37 citation statements)

References 36 publications

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“… Content is partially adopted from the meta‐analysis by Pratschke et al (↑) = significant more, (↓) = significant less, (=) = no significant difference. …”

Section: Discussioncontrasting

confidence: 58%

“…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%

“…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. (29) NOTE: Data are given as n (%). Multivariate analysis showed IAR to be an individual determinant on perioperative blood loss in LT. A possible explanation for this could be that the hepatic artery accounts for less total liver perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, less time may be needed for hemostasis and explantation of the native liver. Furthermore, a better hemodynamic (29) as Well as a recent study by rayar et al (28) showing tPcs versus no tPcs NOTE: Content is partially adopted from the meta-analysis by Pratschke et al (29) (↑) = significant more, (↓) = significant less, (=) = no significant difference. status during surgery due to less venous congestion may result in a more controlled situation.…”

Section: Discussionmentioning

confidence: 99%

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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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“… Content is partially adopted from the meta‐analysis by Pratschke et al (↑) = significant more, (↓) = significant less, (=) = no significant difference. …”

Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…This technique preserves caval flow during the whole procedure and therefore reduces hemodynamic instability and the corresponding negative effect on renal function. In cases where closure of the portal vein is poorly tolerated, especially in patients with metabolic disease or acute liver failure who lack portosystemic collaterals, a temporary portocaval shunt can be constructed 98,99 , and many centers use this as standard technique in LT.…”

Section: Surgical Techniquementioning

confidence: 99%