title: Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature.
abstract: It remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs.
authors.affiliation: Department of General and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Giulia
authors.initials: G
authors.lastname: Manzini
authors.forename: Michael
authors.initials: M
authors.lastname: Kremer
authors.forename: Philipp
authors.initials: P
authors.lastname: Houben
authors.forename: Matthias
authors.initials: M
authors.lastname: Gondan
authors.forename: Wolf O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Berlakovich
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Markus
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authors.lastname: Guba
authors.forename: Werner
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authors.lastname: Hohenberger
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
authors.forename: Hans
authors.initials: H
authors.lastname: Lippert
authors.forename: Thomas
authors.initials: T
authors.lastname: Lorf
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Tscheliessnigg
authors.forename: Dirk
authors.initials: D
authors.lastname: Ysebaert
authors.forename: Heidrun
authors.initials: H
authors.lastname: Binder
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D005060:Europe / Q000453:epidemiology; D006499:Hepatic Artery / Q000502:physiology; D006801:Humans; D008102:Liver Circulation / Q000502:physiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011169:Portal Vein / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D015424:Reperfusion / Q000009:adverse effects / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome