Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis

Autor: C. Cusumano, Nicolas Lombard, Michel Rayar, Laurent Sulpice, M. Lakehal, Bernard Meunier, Christophe Camus, Karim Boudjema, Pauline Houssel-Debry, Véronique Desfourneaux, Giovanni Battista Levi Sandri, Clara Locher
Přispěvatelé: Jonchère, Laurent, Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Rok vydání: 2016
Předmět:
Graft Rejection
Male
Blood transfusion
[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery
medicine.medical_treatment
Kaplan-Meier Estimate
030230 surgery
Liver transplantation
Severity of Illness Index
0302 clinical medicine
medicine.diagnostic_test
Portacaval Shunt
Surgical
Portal Vein
Graft Survival
Age Factors
gamma-Glutamyltransferase
Middle Aged
3. Good health
surgical procedures
operative
Treatment Outcome
Reperfusion Injury
030211 gastroenterology & hepatology
Female
Adult
medicine.medical_specialty
Adolescent
Ischemia
[SDV.CAN]Life Sciences [q-bio]/Cancer
Vena Cava
Inferior
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
Donor Selection
End Stage Liver Disease
03 medical and health sciences
Young Adult
[SDV.CAN] Life Sciences [q-bio]/Cancer
medicine
Humans
Blood Transfusion
Propensity Score
Survival analysis
Aged
Retrospective Studies
Prothrombin time
Transplantation
Hepatology
Donor selection
business.industry
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
medicine.disease
[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Surgery
Liver Transplantation
Propensity score matching
business
Reperfusion injury
Zdroj: Liver Transplantation
Liver Transplantation, 2017, 23 (2), pp.174-183. ⟨10.1002/lt.24650⟩
Liver Transplantation, Wiley, 2017, 23 (2), pp.174-183. ⟨10.1002/lt.24650⟩
ISSN: 1527-6473
1527-6465
DOI: 10.1002/lt.24650⟩
Popis: During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia/reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECDs). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLTs performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group). Patients in the TPCS group required fewer intraoperative transfusions (median number of packed red blood cells-5 versus 6; P = 0.02; median number of fresh frozen plasma-5 versus 6; P = 0.02); had improvement of postoperative biological parameters (prothrombin time, Factor V, international normalized ratio, alkaline phosphatase, and gamma-glutamyltransferase levels); and showed significant reduction of biliary complications (4.7% versus 10.2%; P = 0.006). Survival analysis revealed that TPCS improved 3-month graft survival (94.2% versus 88.6%; P = 0.01) as well as longterm survival of elderly (ie, age > 70 years) donor grafts (P = 0.02). In conclusion, the use of TPCS should be recommended especially when considering an ECD graft. Liver Transplantation 23 174-183 2017 AASLD.
Databáze: OpenAIRE
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