27
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Could retrograde reperfusion combined with washout technique broaden the applicability of marginal grafts in liver transplantation? Intra-operative and short-term outcomes of a prospective cohort Translated title: A reperfusão retrógrada combinada com a lavagem do enxerto pode ampliar a aceitabilidade de fígados limítrofes no transplante hepático? Resultados intraoperatórios e precoces de uma coorte prospectiva

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          ABSTRACT

          Introduction:

          many revascularization techniques were designed to reduce the imbalance of ischemia-reperfusion injury. This study’s objective is to evaluate retrograde reperfusion (RR) compared to sequential anterograde reperfusion (AR), with and without the washout technique (WO).

          Method:

          this prospective cohort study collected data from 94 deceased donor orthotopic liver transplants and divided it into three groups: RR with WO (RR+WO), AP with WO (AR+WO), and AP without WO (AR). This study did not assign the reperfusion technique to the participants. The primary outcome considered the early graft dysfunction, and secondary outcomes included post-reperfusion syndrome (PRS), post-reperfusion lactate, surgery fluid balance, and vasoactive drug dose during the surgery.

          Results:

          87 patients were submitted to the final analysis-29 in the RR+WO group, 27 in the AR+WO group, and 31 in the AR group. Marginal grafts prevalence was not significantly different between the groups (34% vs. 22% vs. 23%; p=0.49) and early graft dysfunction occurred at the same rate (24% vs. 26% vs. 19%; p=0.72). RR+WO reduced serum post-reperfusion lactate (p=0.034) and the incidence of significant PRS (17% vs. 33% vs. 55%; p=0.051), but norepinephrine dosing >0.5mcg/kg/min were not different during the surgery (20,7% vs. 29,6% vs. 35,5%, p=0.45 ).

          Conclusions:

          primary outcome was not significantly different between the groups; however, intraoperative hemodynamic management was safer using the RR+WO technique. We theorized that the RR+WO technique could reduce the incidence of PRS and benefit marginal graft survival following diseased donor orthotopic liver transplantation.

          ABSTRACT

          Introdução:

          várias técnicas de reperfusão foram desenvolvidas a fim de reduzir o dano da lesão induzida por isquemia-reperfusão. Este estudo objetivou avaliar a reperfusão retrograda (RR) comparado com a reperfusão anterógrada (AR), com e sem a realização da técnica de lavagem do enxerto (WO).

          Métodos:

          coorte prospectiva com 94 transplantes ortotópicos de fígado de doador falecido divididos em três grupos: RR com WO (RR+WO), reperfusão anterógrada com WO (AR+WO), e AR sem WO (AR). Este estudo não designou a técnica de reperfusão entre os participantes. O desfecho primário considerou a disfunção precoce do enxerto, e os desfechos secundários incluíram a síndrome pós-reperfusão (SPR), lactato pós-reperfusão, balanço hídrico operatório, e uso de drogas vasoativas durante o ato peratório.

          Resultados:

          87 pacientes foram submetidos para consolidação dos dados-29 no RR+WO, 27 no AR+WO, e 31 no AR. A prevalência de enxertos maginais não diferiu entre os grupos (34% vs 22% vs 23%; p=0,49). Disfunção precoce do enxerto ocorreu em uma proporção similar (24% vs 26% vs 19%; p=0,72). RR+WO reduziu o lactato sérico pós-reperfusão (p=0,034) e a incidência de SPR severa (17% vs 33% vs 55%; p=0,051), entretanto a infusão de noradrenalina >0,5mcg/kg/min não foi diferente durante a cirurgia (20,7% vs 29,6% vs 35,5%, p=0,45).

          Conclusões:

          o desfecho primário não diferiu significativamente entre os grupos; entretanto, o manejo hemodinâmico intra-operatório foi mais seguro no grupo RR+WO. Nós teorizamos que a técnica RR+WO pode reduzir a SPR e beneficiar enxertos marginais no transplante de fígado.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation.

          The greatest part of liver allograft injury occurs during reperfusion, not during the cold ischemia phase. The aim of this study, therefore, was to investigate how the severity of postreperfusion syndrome (PRS) influences short-term outcome for the patient and for the liver allograft. Over a 2-year period, 338 consecutive patients who presented for orthotopic liver transplantation (OLT) were included in this retrospective study. They were divided into 2 groups according to the severity of the PRS they experienced. The first group comprised 152 patients with mild or no PRS; the second group comprised 186 patients with significant PRS. Perioperative hemodynamic parameters, coagulation profiles, blood product requirements, incidence of infection, incidence of rejection and outcome data for both groups were collected and analyzed. There was no demographic difference between the groups except for age; group 2 had older patients than group 1 (54.94 +/- 9.07 versus 51.52 +/- 9.91, P = 0.001). Compared to group 1, group 2 patients required more red blood cell transfusions (11.31 +/- 10.90 versus 8.08 +/- 7.89 units, P = 0.002), more fresh frozen plasma transfusions (10.25 +/- 10.96 versus 7.03 +/- 7.64 units, P = 0.002), more cryoprecipitate (1.88 +/- 4.72 units versus 0.61 +/- 1.80 units, P = 0.001), and were more likely to suffer from fibrinolysis (52.7% versus 41.4%, P = 0.041). Interestingly, group 2 had a shorter average warm ischemia time than group 1 (33.19 +/- 8.55 versus 36.21 +/- 11.83 minutes, P = 0.01). Group 2 also required longer, on average, mechanical ventilation (14.95 +/- 29.79 versus 8.55 +/- 17.79 days, P = 0.015), remained in the intensive care unit longer (17.65 +/- 31.00 versus 11.49 +/- 18.67 days, P = 0.025), and had a longer hospital stay (27.29 +/- 32.35 versus 20.85 +/- 21.08 days, P = 0.029). Group 2 was more likely to require retransplantation (8.6% versus 3.3%, P = 0.044). In conclusion, the severity of PRS during OLT appears to be related to the outcome of patient and liver allograft. (c) 2008 AASLD.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Evolution of Liver Transplantation

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Influence of retrograde flushing via the caval vein on the post-reperfusion syndrome in liver transplantation.

              The reperfusion phase during orthotopic liver transplantation (LTX) is a critical event with sometimes profound hemodynamic and cardiac changes. We present the influence of retrograde reperfusion in LTX on the post-reperfusion syndrome (PRS). Fifty-six LTXs in 53 patients were performed with the piggy-back technique with retrograde reperfusion via the caval vein and antegrade reperfusion via the portal vein. The incidence of PRS was evaluated. We observed a PRS in two patients (3.6%), four patients (7.1%) had a decrease in mean arterial pressure (MAP) of 20-29%, 18 patients (32.2%) of 10-19%, 27 patients (48.2%) of 1-9% and five patients (8.9%) had a small increase in MAP. Our retrospective study showed that retrograde reperfusion seems to maintain stability during the reperfusion phase. Hemodynamic disturbances during LTX were uncommon, leading us to suppose that the incidence of PRS could be diminished with retrograde reperfusion.
                Bookmark

                Author and article information

                Contributors
                On behalf of : TCBC-PE
                On behalf of : ACBC-PE
                Journal
                Rev Col Bras Cir
                Rev Col Bras Cir
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Colégio Brasileiro de Cirurgiões
                0100-6991
                1809-4546
                22 June 2023
                2023
                : 50
                : e20233489
                Affiliations
                [1 ] - Hospital Universitário Oswaldo Cruz, Unidade de Transplante de Fígado - Recife - PE - Brasil
                [2 ] - Universidade de Pernambuco, Faculdade de Ciência Médicas - Recife - PE - Brasil
                Author notes
                Mailing address: Luiz Eduardo Rafael Moutinho E-mail: luiz.moutinho@ 123456upe.br

                Conflict of interest: no.

                Author information
                http://orcid.org/0000-0002-2383-8610
                http://orcid.org/0000-0002-6232-935X
                http://orcid.org/0000-0001-6191-6336
                http://orcid.org/0000-0001-7137-4323
                http://orcid.org/0000-0002-8873-314X
                http://orcid.org/0000-0002-2056-1599
                http://orcid.org/0000-0002-2115-7838
                Article
                00222
                10.1590/0100-6991e-20233489-en
                10508661
                37436281
                192fdc1d-9215-40bf-b31c-70fa1aebf021
                © 2023 Revista do Colégio Brasileiro de Cirurgiões

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 22 October 2022
                : 06 April 2023
                Page count
                Figures: 6, Tables: 2, Equations: 0, References: 15
                Categories
                Original Article

                liver transplantation,reperfusion injury,bile ducts,donor selection,transplante de fígado,reperfusão,ductos biliares,seleção do doador

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content44

                Cited by1

                Most referenced authors186