title: The beneficial impact of temporary porto-caval shunt in orthotopic liver transplantation: a single center analysis.
abstract: The use of temporary porto-caval shunt (TPCS) has been shown to improve hemodynamic stability and renal function in patients undergoing orthotopic liver transplantation (OLT). We evaluated the impact of TPCS in OLT and analyzed the differences according to model for end-stage liver disease (MELD), donor risk index (DRI) and D-MELD. This is a retrospective single-center analysis of 148 consecutive OLT. Fifty-eight OLT were performed using TPCS and 90 without TPCS. Donor and recipient data with pre-OLT, intraoperative and postoperative variables were reviewed. Overall graft survival was 89.9% at 3 months and 81.7% at 1 year. Graft survival at 3 months and 1 year was 93.1% and 79.2%, respectively, in TPCS group versus 85.6% and 82.2%, respectively, in non-TPCS group (P = NS). Intraoperative packed red blood cells requirement was lower in TPCS group (7.5 ± 5.8 vs. 12.2 ± 14.2, P = 0.006) and non-TPCS group required higher intraoperative total dose of phenylephrine (16% vs. 28%, P = 0.04). TPCS group had lower 30-day postoperative mortality (1.7% vs. 10%, P = 0.04), no difference was observed at 90 days. Graft survival was lower in patients with high DRI; in this group graft loss was higher at 1 month (25% vs. 4.3%, P = 0.005) and 3 months (25% vs. 4.3%, P = 0.005) when TPCS was not used. TPCS improves perioperative outcome, this being more evident when high-risk grafts are placed into high-risk patients.
authors.affiliation: Department of General Surgery and Liver Transplantation, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ghinolfi
authors.forename: Josep
authors.initials: J
authors.lastname: Martí
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Rodríguez-Laiz
authors.forename: Mark
authors.initials: M
authors.lastname: Sturdevant
authors.forename: Kishore
authors.initials: K
authors.lastname: Iyer
authors.forename: Domenico
authors.initials: D
authors.lastname: Bassi
authors.forename: Corey
authors.initials: C
authors.lastname: Scher
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sogawa
authors.forename: Juan
authors.initials: J
authors.lastname: del Rio Martin
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D012189:Retrospective Studies; D016896:Treatment Outcome