title: Temporary Intraoperative Porto-Caval Shunts in Piggy-Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta-Analysis.
abstract: The value of temporary intraoperative porto-caval shunts (TPCS) in cava-sparing liver transplantation is discussed controversially. Aim of this meta-analysis was to analyze the impact of temporary intraoperative porto-caval shunts on liver injury, primary non-function, time of surgery, transfusion of blood products and length of hospital stay in cava-sparing liver transplantation.
  
  
  
  A systematic search of MEDLINE/PubMed, EMBASE and PsycINFO retrieved a total of 909 articles, of which six articles were included. The combined effect size and 95 % confidence interval were calculated for each outcome by applying the inverse variance weighting method. Tests for heterogeneity (I2) were also utilized.
  
  
  
  Usage of a TPCS was associated with significantly decreased AST values, significantly fewer transfusions of packed red blood cells and improved postoperative renal function. There were no statistically significant differences in primary graft non-function, length of hospital stay or duration of surgery.
  
  
  
  This meta-analysis found that temporary intraoperative porto-caval shunts in cava-sparing liver transplantation reduce blood loss as well as hepatic injury and enhance postoperative renal function without prolonging operative time. Randomized controlled trials investigating the use of temporary intraoperative porto-caval shunts are needed to confirm these findings.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pratschke
authors.affiliation: Chair for Public Health and Health Care Research, Research Unit for Biopsychosocial Health, Department of Medical Informatics, Biometry and Epidemiology - IBE, Ludwig Maximilians-University, Munich, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Rauch
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Albertsmeier
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Rentsch
authors.affiliation: Chair for Public Health and Health Care Research, Research Unit for Biopsychosocial Health, Department of Medical Informatics, Biometry and Epidemiology - IBE, Ludwig Maximilians-University, Munich, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Kirschneck
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Andrassy
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.affiliation: Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Dr Josep Trueta Hospital, Institut d'Investigació Biomèdica (IDIBGi), Girona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Figueras
authors.affiliation: Auxilio Centro de Transplante, Hospital Español Auxilio Mutuo, San Juan, PR, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Del Rio Martin
authors.affiliation: Liver Transplantation Center, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Ruvo
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Weniger
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany. Martin.Angele@med.uni-muenchen.de.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017707:Erythrocyte Transfusion; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007668:Kidney / Q000502:physiology; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods*; D011167:Portacaval Shunt, Surgical; D011184:Postoperative Period
chemical_list: D001219:Aspartate Aminotransferases