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

TY - JOUR

T1 - Reperfusion of liver graft during transplantation

T2 - Techniques used in transplant centres within Eurotransplant and meta-analysis of the literature

AU - Manzini, G.

AU - Kremer, M.

AU - Houben, P.

AU - Binder, H.

AU - Schemmer, P.

AU - Gondan, Matthias

AU - Bechstein, W.O.

AU - Becker, Thomas

AU - Berlakovich, G.A.

AU - Friess, H.

AU - Guba, M.

AU - Hohenberger, W.

AU - Ijzermans, J.N.M.

AU - Jonas, S.

AU - Kalff, J.C.

AU - Klar, E.

AU - Klempnauer, J.

AU - Lerut, J.

AU - Lippert, Hanne

AU - Lorf, T.

AU - Nadalin, S.

AU - Nashan, B.

AU - Otto, G.

AU - Paul, A.

AU - Pirenne, J.

AU - Pratschke, J.

AU - Ringers, J.

AU - Rogiers, X.

AU - Schilling, M.K.

AU - Seehofer, D.

AU - Senninger, N.

AU - Settmacher, U.

AU - Stippel, D.L.

AU - Tscheliessnigg, K.

AU - Ysebaert, D.

PY - 2013/5/1

Y1 - 2013/5/1

N2 - It 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, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs.

AB - It 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, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs.

UR - http://www.scopus.com/inward/record.url?scp=84876475499&partnerID=8YFLogxK

U2 - 10.1111/tri.12083

DO - 10.1111/tri.12083

M3 - Journal article

C2 - 23517278

AN - SCOPUS:84876475499

SN - 0934-0874

VL - 26

SP - 508

EP - 516

JO - Transplant International

JF - Transplant International

IS - 5

ER -