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: OLIVAL CIRILO NETO, LUIZ EDUARDO RAFAEL MOUTINHO, PAULO SÉRGIO VIEIRA DE MELO, LUDMILA RODRIGUES COSTA, PRISCYLLA JENNIE MONTEIRO RABÊLO, AMERICO GUSMÃO AMORIM, CLÁUDIO MOURA LACERDA MELO
Jazyk: English<br />Spanish; Castilian<br />Portuguese
Rok vydání: 2023
Předmět:
Zdroj: Revista do Colégio Brasileiro de Cirurgiões, Vol 50 (2023)
Druh dokumentu: article
ISSN: 1809-4546
0100-6991
DOI: 10.1590/0100-6991e-20233489-en
Popis: ABSTRACT 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: Directory of Open Access Journals
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