Prolonged hepatic inflow occlusion to reduce bleeding during recipient hepatectomy in living donor liver transplantation

Autor:	Gil-Chun Park, Hui-Dong Cho, Tae Yong Ha, I-Ji Chung, Jin Uk Choi, Shin Hwang, Sang-Hyun Kang, Young-In Yoon, Dong-Hwan Jung, Deok-Bog Moon, Sung-Gyu Lee, Chul-Soo Ahn, Gi-Won Song, Ki-Hun Kim
Rok vydání:	2020
Předmět:	medicine.medical_specialty business.industry medicine.medical_treatment Dissection (medical) medicine.disease Surgery body regions Liver disease medicine Portal hypertension Inflow occlusion Hepatectomy Complication Living donor liver transplantation business Splanchnic
Zdroj:	Korean Journal of Transplantation. 34:55-61
ISSN:	2671-8804 2671-8790
DOI:	10.4285/kjt.2020.34.1.55
Popis:	Background: Living donor liver transplantation (LDLT) causes bleeding in recipients during the careful preservation of most perihilar structures during this surgery. This case-control study aimed to analyze the effect of prolonged hepatic inflow occlusion (PHIO) when applied during recipient hepatectomy in LDLT. Methods: The study group comprised patients who underwent PHIO with Model for End-Stage Liver Disease (MELD) scores ranging from 26 to 35 (n=20). The following two control groups were selected according to their MELD scores: the low-MELD score group (MELD scores of 15-20, n=40) and the high-MELD score group (MELD scores of 26-35, n=40). Total dissection time for hepatic mobilization and dissection and blood loss during these procedures were compared between the two groups. Results: In the PHIO study group, mean total dissection time and mean PHIO duration were 226.3±59.4 and 68.2±19.1 minutes, respectively. Twelve patients underwent PHIO twice, and the other eight patients underwent PHIO once. The low-MELD score control group and the PHIO study group showed similar dissection duration (216.0±43.9 vs. 226.3±59.4 minutes, P=0.82) and similar blood loss volume during dissection (2,112.5±1,614.9 vs. 2,350.0±951.9 mL, P=0.17). The high-MELD score control group and the PHIO study group showed similar dissection duration (241.0±41.9 vs. 226.3±59.4 minutes, P=0.71), but the PHIO group showed a significantly lower blood loss during dissection than the high-MELD score group (2,350.0±951.9 vs. 2,815.0±1,813.9 mL, P=0.002). During and after PHIO, no adverse complication was observed, except for transient splanchnic congestion. Conclusions: Our findings suggest that PHIO is a simple effective method to reduce intraoperative bleeding during hepatic mobilization and dissection during LDLT operation requiring difficult dissection.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4eb78c9d3fc2a85ef1504077a0340176 https://doi.org/10.4285/kjt.2020.34.1.55 Zobrazit plný text záznamu