Temporary portocaval shunt in orthotopic liver transplantation: Need for a standardized approach?

Abstract

Maintenance of portal and systemic venous return during the anhepatic phase of liver transplantation (LT) improves hemodynamic stability. With the piggyback technique, caval return is maintained; however, temporary clamping of the portal vein is still necessary. The use of a temporary portocaval shunt (TPCS) has been proposed to minimize the effect of portal venous interruption. The aim of this study was to perform a systematic review of the literature to determine whether there is evidence to support the routine use of a TPCS in LT. An electronic search of the literature from 1963 to 2007 was performed. A total of 4386 articles were identified, of which 8 met all the criteria and were included in the study. Because of the variability in reporting and the small number of studies, statistical comparison was not possible; however, a trend toward a shorter operative time, less blood product transfusion, and maintenance of higher mean arterial pressures during portal vein clamping was seen in patients with a TPCS. In conclusion, the available evidence, albeit scarce, supports the use of a TPCS in patients undergoing LT. A prospective randomized study of patients most likely to benefit from a TPCS is necessary to substantiate these findings.

Liver transplantation in Indian Armed Forces—initial experience

“…We find early creation of a temporary portocaval shunt very useful to reduce bleeding as well as avoid splanchnic congestion. 8 The first anastomosis at implantation of the graft is the outflow anastomosis (Figure 3). The next anastomosis is the portal vein anastomosis and it is important to ensure no redundancy and anastomotic narrowing is avoided by leaving a growth factor.…”

“…Ensuring integrity of the blood supply to the biliary tree, transecting the bile ducts along with the hilar plate and refinement in techniques of biliary anastomosis in LDLT has resulted in a significant reduction in the incidence of biliary complications from 24.3-40.6% before 2007 to 5. [3][4][5][6][7][8][9][10][11][12].8% in studies published after 2008 (Table 6). [27][28][29][30][31][32][33][34] Overall biliary complications in LDLT in our series was seen in three recipients (16.6%) which compares well with other studies.…”

Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis

“…However, that study failed to show an improvement in graft function in the TPCS group, probably due to the limited sample size (40 patients in each group) with almost no ECD grafts. Other studies have confirmed the benefit of TPCS on blood transfusion, intraoperative hemodynamic status, and reduction of reperfusion syndrome incidence . As for graft outcome and function, Ghinolfi et al reported their series of 148 OLTs and found a significant reduction in 30‐day mortality in the TPCS group and in 3‐month mortality when the patients received high‐risk donor grafts.…”

Recanalized umbilico‐caval anastomosis as a temporary portosystemic shunt in pediatric living donor liver transplantation: the crossed fingers method

“…The exact mechanisms underlying the protective properties of a temporary portocaval shunt still remain unknown. However, recent studies have reported beneficial effects of using a portocaval shunt, as enhanced portal blood flow has been shown to be associated with reduced liver injury following post‐reperfusion hemodynamic instability . Some mediators released from the gut, such as proinflammatory cytokines, endotoxin, and chemokines, caused by splanchnic congestion, may be responsible for the observed liver injury in patients without a shunt.…”