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

G Manzini, Maarten Kremer, P Houben, M Gondan, WO Bechstein, T Becker, GA Berlakovich, H Friess, M Guba, W Hohenberger, J.N.M. IJzermans, S Jonas, JC Kalff, E Klar, J Klempnauer, J Lerut, H Lippert, T Lorf, S Nadalin, B NashanG Otto, A Paul, J Pirenne, J Pratschke, J Ringers, X Rogiers, MK Schilling, D Seehofer, N Senninger, U Settmacher, DL Stippel, K Tscheliessnigg, D Ysebaert, H Binder, P Schemmer

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Abstract

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.
Original languageUndefined/Unknown
Pages (from-to)508-516
Number of pages9
JournalTransplant International
Volume26
Issue number5
DOIs
Publication statusPublished - 2013

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