Technical Aspects of Orthotopic Liver Transplantation-a Survey-Based Study Within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks.

Autor: Czigany Z; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany., Scherer MN; Department of Surgery and Transplantation, University Hospital Regensburg, Regensburg, Germany., Pratschke J; Department of Surgery and Transplantation, University Hospital Berlin - Charité, Berlin, Germany., Guba M; Department of Surgery, University Hospital Munich, Munich, Germany., Nadalin S; Department of Surgery and Transplantation, University Hospital Tuebingen, Tuebingen, Germany., Mehrabi A; Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany., Berlakovich G; Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria., Rogiers X; Department of Solid Organ Transplantation, University Hospital Gent, Ghent, Belgium., Pirenne J; Department of Hepatobiliary Surgery and Transplantation, University Hospital Leuven, Leuven, Belgium., Lerut J; Unit of Liver Transplantation and General Surgery, University Hospitals St.-Luc, Brussels, Belgium., Mathe Z; Department of Surgery and Transplantation, Semmelweis University, Budapest, Hungary., Dutkowski P; Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland., Ericzon BG; Department of Solid Organ Transplantation, University Hospital Stockholm - Karolinska Institute, Stockholm, Sweden., Malagó M; Department of Hepatobiliary Surgery and Transplantation, University College London, London, UK., Heaton N; Department of Hepatobiliary Surgery and Transplantation, King's College Hospital, London, UK., Schöning W; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany., Bednarsch J; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany., Neumann UP; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany., Lurje G; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany. glurje@ukaachen.de.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2019 Mar; Vol. 23 (3), pp. 529-537. Date of Electronic Publication: 2018 Aug 10.
DOI: 10.1007/s11605-018-3915-6
Abstrakt: Background: Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. However, technical aspects of OLT are still subject of ongoing debate and are widely based on personal experience and local institutional protocols.
Methods: An international online survey was sent out to all liver transplant centers (n = 52) within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplant Society networks. The survey sought information on center-specific OLT caseload, vascular and biliary reconstruction, graft reperfusion, intraoperative control of hemodynamics, and drain policies.
Results: Forty-two centers gave a valid response (81%). Out of these, 50% reported piggy-back and 40.5% total caval replacement as their standard technique. While 48% of all centers generally do not apply veno-venous bypass (vvBP) or temporary portocaval shunt (PCS) during OLT, vvBP/PCS are routinely used in six centers (14%). Portal vein first reperfusion is used in 64%, followed by simultaneous (17%), and retrograde reperfusion (12%). End-to-end duct-to-duct anastomosis without biliary drain (67%) is the most frequently performed method of biliary reconstruction. No significant associations were found between the center caseload and the surgical approach used. The predominant part of the centers (88%) stated that techniques of OLT are not evidence-based and 98% would participate in multicenter clinical trials on these topics.
Conclusion: Technical aspects of OLT vary widely among European centers. The extent to which center-specific variation of techniques affect transplant outcomes in Europe should be elucidated further in prospective multicenter trials.
Databáze: MEDLINE
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