Antegrade Arterial and Portal Flushing Versus Portal Flushing Only for Right Lobe Live Donor Liver Transplantation-A Randomized Control Trial
| Autor: | Rommel Sandhyav, Viniyendra Pamecha, Kishore Gurumoorthy Subramanya Bharathy, Piyush Kumar Sinha, Shridhar Vasantrao Sasturkar |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Randomization Time Factors Bilirubin medicine.medical_treatment India 030230 surgery Liver transplantation law.invention Sepsis 03 medical and health sciences chemistry.chemical_compound Liver disease 0302 clinical medicine Hepatic Artery Cholestasis law Risk Factors medicine Living Donors Humans Hospital Mortality Adverse effect Transplantation business.industry Portal Vein Length of Stay Middle Aged medicine.disease Intensive care unit Surgery Liver Transplantation Perfusion Intensive Care Units Treatment Outcome chemistry Liver 030211 gastroenterology & hepatology Female Primary Graft Dysfunction business Liver Circulation |
| Zdroj: | Transplantation. 102(4) |
| ISSN: | 1534-6080 |
| Popis: | BACKGROUND In live donor liver transplantation portal flush only of the graft is done on the bench. There are no data on antegrade arterial flush along with portal flush of the graft. METHODS Consecutive patients undergoing elective right lobe live donor liver transplantation were block-randomized to receive either portal flush only or both portal and antegrade arterial flush. The primary objectives were safety, rate of early allograft dysfunction (EAD), and impact on vascular and biliary complications. RESULTS After randomization, there were 40 patients in each group. Both groups had comparable preoperative, intraoperative, and donor variables. There were no adverse events related to arterial flushing. The portal and antegrade arterial flush group had significantly lower postoperative bilirubin on days 7, 14, and 21 (all P < 0.05), EAD (P = 0.005), intensive care unit/high dependency unit (P = 0.01), and hospital stay (P = 0.05). This group also had lower peak aspartate aminotransferase (P = 0.07), alanine aminotransferase (P = 0.06) and lower rates of sepsis (P = 0.08) trending toward statistical significance. Portal and antegrade arterial flush groups had lower ascitic fluid drainage and in-hospital mortality. Arterial and biliary complications were not statistically different in the 2 groups. Multivariate analysis of EAD showed portal with antegrade arterial flush was associated with lower rate (P = 0.007), whereas model for end-stage liver disease Na (P = 0.01) and donor age (P = 0.03) were associated with a higher rate of EAD. CONCLUSIONS Portal with antegrade arterial flushing of right lobe live liver grafts is safe, significantly decreases postoperative cholestasis, EAD, intensive care unit/high dependency unit, and hospital stay and is associated with lower rates of sepsis, ascitic drainage and inhospital mortality in comparison to portal flush only. |
| Databáze: | OpenAIRE |
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