Short-term effects of extracorporeal graft rinse versus circulatory graft rinse in living donor liver transplantation. A Prospective Randomized Controlled Trial.
Yassen AM, Elsarraf WR, et al.Transplant International 2017; 12: 12.
Aims
To examine the effect of introducing graft preservative solution and mesenteric blood into the systemic circulation on operative course and post-operative outcomes in living donor liver transplantation (LDLT).
Interventions
On ending portal vein anastomosis, grafts were flushed by patient’s portal blood. Participants were randomised whereby this occurred either through incompletely anastomosed hepatic vein (Extracorporeal Rinse; Control group) or into systemic circulation (Circulatory Rinse; Treatment group).
Participants
80 adult recipients aged 20-60 years who underwent LDLT with right lobe liver graft in the Mansoura University liver transplantation program.
Outcomes
The primary outcome measured was the lowest mean arterial blood pressure within 5 minutes after portal unclamping as a marker for post-reperfusion syndrome. Secondary measures included hemodynamic and laboratory outcomes, and length of intensive care and hospital stay, early post-operative complications, graft rejection, ischemia/reperfusion injury and three months’ patient survival.
Follow-up
3 months
CET Conclusions
In this study partial liver grafts from live donors were reperfused with donor portal blood either into the recipient's circulation, or through an incomplete venous anastomosis, whereby the rinsed blood was suctioned out. There was a statistically significant difference in the primary outcome, lowest MAP within the first 5 minutes after reperfusion. Although the difference between the mean values is very small (66mmHg versus 57.8mmHg), slightly favouring the extra-corporeal flush. This drop in MAP was, as might be expected, accompanied by a drop in SVR. There were more patients with a significant drop in MAP (>30%) and severe hypotension (MAP<60mmHg) in the circulatory rinse group however. Despite this apparent difference in post-reperfusion haemodynamics, in both sets of patients these rapidly normalised.
Data analysis
Strict intention-to-treat analysis
Trial registration
Clinicaltrials.gov - NCT02540447