title: Temporary intraoperative porto-caval shunt: useless or beneficial in piggy back liver transplantation?
abstract: The role of intraoperative porto-caval shunts in orthotopic liver transplantation (OLT) is controversial. Aim of this study was to analyze the effects of an intraoperative, porto-caval catheter-shunt on graft function and survival following cava sparing OLT. Four hundred and forty-eight piggy back liver transplantations with or without a temporary spontaneous porto-caval shunt between 1997 and 2010 were analyzed (shunt n = 274 vs. no shunt n = 174). Lab MELD scores and donor risk indices (DRI) were calculated. Hepatic injury (ALT, AST), -function (bilirubin, prothrombin ratio), postreperfusion liver blood flow and graft survival were registered [mean follow-up: 50.5 (0-163.0) months]. The impact of a shunt on graft survival was determined using multivariate analysis. Usage of a porto-caval shunt was associated with reduced hepatic injury (ALT, AST), whereas graft function was not affected. The shunt group showed a significantly increased portal venous blood flow after reperfusion. Retransplantation rate was decreased (7.7% vs. 20.1%, P = 0.001) and long-term graft survival was significantly increased with a porto-caval shunt (hazard ratio 2.1, P < 0.001). This effect was even more pronounced for marginal organs. Usage of intraoperative porto-caval catheter-shunts is beneficial in cava sparing OLT and is associated with reduced ischemia-reperfusion injury and improved organ survival in particular for recipients of marginal organs.
authors.affiliation: Department of Surgery, University of Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pratschke
authors.forename: Georgios
authors.initials: G
authors.lastname: Meimarakis
authors.forename: Christiane J
authors.initials: CJ
authors.lastname: Bruns
authors.forename: Michael
authors.initials: M
authors.lastname: Kaspar
authors.forename: Niclas
authors.initials: N
authors.lastname: Prix
authors.forename: Reinhart
authors.initials: R
authors.lastname: Zachoval
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Florian
authors.initials: F
authors.lastname: Loehe
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011167:Portacaval Shunt, Surgical; D012086:Reoperation