Transplant Trial Watch

Temporary Portocaval Shunt Provides Superior Intra-operative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation: A Randomized Control Trial.

Yl, M. K., et al.

Annals of Surgery 2024 [record in progress].

This study aimed to investigate the role of temporary portocaval shunt (TPCS) during recipient hepatectomy in live donor liver transplant recipients.

Participants were randomised to TPCS versus no TPCS.

60 live donor liver transplantation (LDLT) recipients.

The primary outcomes are intraoperative haemodynamic parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure), blood loss, transfusion requirement, renal function, and duration of surgery. The secondary outcomes include early graft dysfunction, morbidity, mortality, total ICU and hospital stay.

90 days

CET Conclusions
Temporary portocaval shunt (TPCS) formation is a frequently utilised in liver transplantation to reduce portal hypertension and blood loss during the hepatectomy phase. The benefit of this technique has been proven in acute liver failure, where physiological portosystemic shunts are not well developed, but the benefit in cases of chronic liver disease with cirrhosis is less clear. This unblinded randomised trial investigated the efficacy of TPCS in chronic liver patients undergoing live donor liver transplant. Intra-operative parameters including inotrope requirement, blood loss and renal function were significantly improved in the TPCS group. However, these superior haemodynamic parameters did not result in meaningful post-operative benefit, with no significant differences in key clinical parameters including morbidity, mortality and length of stay between the two groups. The technique should thus continue to be utilised on a case by case basis.

Jadad score

Data analysis
Strict intention-to-treat analysis

Allocation concealment

Trial registration - NCT05385120

Funding source
No funding received