title: Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis.
abstract: During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia/reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECDs). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLTs performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group). Patients in the TPCS group required fewer intraoperative transfusions (median number of packed red blood cells-5 versus 6; P = 0.02; median number of fresh frozen plasma-5 versus 6; P = 0.02); had improvement of postoperative biological parameters (prothrombin time, Factor V, international normalized ratio, alkaline phosphatase, and gamma-glutamyltransferase levels); and showed significant reduction of biliary complications (4.7% versus 10.2%; P = 0.006). Survival analysis revealed that TPCS improved 3-month graft survival (94.2% versus 88.6%; P = 0.01) as well as longterm survival of elderly (ie, age > 70 years) donor grafts (P = 0.02). In conclusion, the use of TPCS should be recommended especially when considering an ECD graft. Liver Transplantation 23 174-183 2017 AASLD.
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.|INSERM, CIC 1414, Rennes, France.|Faculté de Médecine, Université Rennes 1, Rennes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Rayar
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Levi Sandri
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Caterina
authors.initials: C
authors.lastname: Cusumano
authors.affiliation: Service de Pharmacologie Clinique et Épidémiologique, Centre Hospitalier Universitaire Rennes, Rennes, France.|INSERM, CIC 1414, Rennes, France.|Faculté de Médecine, Université Rennes 1, Rennes, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Locher
authors.affiliation: Service des Maladies du Foie, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Houssel-Debry
authors.affiliation: Réanimation Médicale, Centre Hospitalier Universitaire Rennes, Rennes, France.|INSERM, CIC 1414, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Camus
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lombard
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Desfourneaux
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lakehal
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.|Faculté de Médecine, Université Rennes 1, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.|INSERM, CIC 1414, Rennes, France.|Faculté de Médecine, Université Rennes 1, Rennes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.|INSERM, CIC 1414, Rennes, France.|Faculté de Médecine, Université Rennes 1, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion; D046148:Donor Selection / Q000379:methods; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000601:surgery; D057216:Propensity Score; D015427:Reperfusion Injury / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery; D055815:Young Adult; D005723:gamma-Glutamyltransferase
chemical_list: D005723:gamma-Glutamyltransferase