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.

Autor:	Cirilo Neto O; - Hospital Universitário Oswaldo Cruz, Unidade de Transplante de Fígado - Recife - PE - Brasil., Moutinho LER; - Universidade de Pernambuco, Faculdade de Ciência Médicas - Recife - PE - Brasil., Melo PSV; - Hospital Universitário Oswaldo Cruz, Unidade de Transplante de Fígado - Recife - PE - Brasil., Costa LR; - Universidade de Pernambuco, Faculdade de Ciência Médicas - Recife - PE - Brasil., Rabêlo PJM; - Hospital Universitário Oswaldo Cruz, Unidade de Transplante de Fígado - Recife - PE - Brasil., Amorim AG; - Hospital Universitário Oswaldo Cruz, Unidade de Transplante de Fígado - Recife - PE - Brasil., Melo CML; - Hospital Universitário Oswaldo Cruz, Unidade de Transplante de Fígado - Recife - PE - Brasil.
Jazyk:	English; Portuguese
Zdroj:	Revista do Colegio Brasileiro de Cirurgioes [Rev Col Bras Cir] 2023 Jul 10; Vol. 50, pp. e20233489. Date of Electronic Publication: 2023 Jul 10 (Print Publication: 2023).
DOI:	10.1590/0100-6991e-20233489-en
Abstrakt:	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.
Databáze:	MEDLINE
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