title: Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis.
abstract: OBJECTIVE
  We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation.
  
  
  METHODS
  A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ(2) and I (2) tests. The risk of publication bias was assessed using a funnel plot and Egger's test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches.
  
  
  RESULTS
  Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001), and intensive care unit (ICU) days were decreased (MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis.
  
  
  CONCLUSIONS
  The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Jia-Zhong
authors.initials: JZ
authors.lastname: Wang
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Jin-Long
authors.initials: JL
authors.lastname: Wang
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Le
authors.initials: L
authors.lastname: Lu
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Ya-Fei
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Lu
authors.affiliation: Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Afﬁliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710004, Shaanxi Province, China.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D001660:Biliary Tract Diseases / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016017:Odds Ratio; D061646:Operative Time; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: Biliary complications; Liver transplantation; Meta-analysis; Outcomes; Revascularization