The beneficial impact of temporary porto-caval shunt in orthotopic liver transplantation: a single center analysis

Abstract

Summary The use of temporary porto‐caval shunt (TPCS) has been shown to improve hemodynamic stability and renal function in patients undergoing orthotopic liver transplantation (OLT). We evaluated the impact of TPCS in OLT and analyzed the differences according to model for end‐stage liver disease (MELD), donor risk index (DRI) and D‐MELD. This is a retrospective single‐center analysis of 148 consecutive OLT. Fifty‐eight OLT were performed using TPCS and 90 without TPCS. Donor and recipient data with pre‐OLT, intraoperative and postoperative variables were reviewed. Overall graft survival was 89.9% at 3 months and 81.7% at 1 year. Graft survival at 3 months and 1 year was 93.1% and 79.2%, respectively, in TPCS group versus 85.6% and 82.2%, respectively, in non‐TPCS group (P = NS). Intraoperative packed red blood cells requirement was lower in TPCS group (7.5 ± 5.8 vs. 12.2 ± 14.2, P = 0.006) and non‐TPCS group required higher intraoperative total dose of phenylephrine (16% vs. 28%, P = 0.04). TPCS group had lower 30‐day postoperative mortality (1.7% vs. 10%, P = 0.04), no difference was observed at 90 days. Graft survival was lower in patients with high DRI; in this group graft loss was higher at 1 month (25% vs. 4.3%, P = 0.005) and 3 months (25% vs. 4.3%, P = 0.005) when TPCS was not used. TPCS improves perioperative outcome, this being more evident when high‐risk grafts are placed into high‐risk patients.

Comparison of three caval reconstruction techniques in orthotopic liver transplantation: A retrospective review

“…Equivalent surgical times have been observed between cases with and without TPCS is attributed to the time spent performing TPCS regained with an easier hepatectomy done on a fully devascularized organ, and shorter final hemostasis. 20,21 The observed frequency of cardiac arrest at reperfusion was low (3%), and occurred in the Classic and PB groups. No cardiac arrests were observed in the SS group.…”

Strategies to optimize the use of marginal donors in liver transplantation

“…Impaired renal perfusion, vascular instability and the release of cytokines at reperfusion contribute to a reduction in renal function [102] . In a study by Ghinolfi et al [100] it has been shown to improve hemodynamic stability and renal function in patients undergoing orthotopic LT. Lower graft survival rates were reported in patients of high DRI liver grafts when a TPCS was not used [100] . TPCS improves the perioperative outcome, this being more evident when highrisk grafts are allocated to high-risk patients [100] .…”

“…In a study by Ghinolfi et al [100] it has been shown to improve hemodynamic stability and renal function in patients undergoing orthotopic LT. Lower graft survival rates were reported in patients of high DRI liver grafts when a TPCS was not used [100] . TPCS improves the perioperative outcome, this being more evident when highrisk grafts are allocated to high-risk patients [100] . Another series by Pratschke et al [103] showed reduced hepatic injury and increased portal flow after reperfusion.…”

“…At transplantation, the main strategies encompass the modality of graft reperfusion and use of temporary porto-caval shunts [97][98][99][100] . Graft reperfusion can be sequential or simultaneous.…”

Reply

“…(3) Use of a temporary portocaval shunt (TPCS) has been reported to reduce the need for vasopressors, to provide better hemodynamic stability and splanchnic outflow, and to decrease the risk of postreperfusion syndrome, (4,5) with a varied benefit on graft and patient survival. (6) Such advantages may be of great importance in the setting of graft marginality like elderly donation and/or in severely compromised recipients.…”