title: Short-term effects of extracorporeal graft rinse versus circulatory graft rinse in living donor liver transplantation. A prospective randomized controlled trial.
abstract: Living donor liver transplantation has shorter cold ischemia time, less preservative volume, and lower metabolic load compared to transplantation from deceased donors. We investigated the impact of rinsing the graft contents into the systemic circulation on operative course and postoperative outcomes. Donors had right hepatectomy, and grafts were preserved with cold histidine-tryptophan-ketoglutarate solution. On ending portal vein anastomosis, grafts were flushed by patient's portal blood either through incompletely anastomosed hepatic vein (extracorporeal rinse group, EcRg, n = 40) or into systemic circulation (circulatory rinse group, CRg, n = 40). The primary outcome objective was the lowest mean arterial blood pressure within 5 min after portal unclamping as a marker for postreperfusion syndrome (PRS). Secondary objectives included hemodynamics and early graft's and patient's outcomes. Within 5 min postreperfusion, mean arterial blood pressure was significantly lower in the CRg compared to the EcRg, yet this was clinically insignificant. Postoperative graft functions, early biliary and vascular complications, and three-month survival were comparable in both groups. Rinsing the graft into the circulation increased the incidence of PRS without significant impact on early graft or patient outcome in relatively healthy recipients.
authors.affiliation: Department of Anesthesia and Intensive Care, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Amr M
authors.initials: AM
authors.lastname: Yassen
authors.affiliation: Department of Anesthesia and Intensive Care, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Waleed R
authors.initials: WR
authors.lastname: Elsarraf
authors.affiliation: Department of Anesthesia and Intensive Care, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Mohamed A
authors.identifier: http://orcid.org/0000-0002-0984-0853
authors.initials: MA
authors.lastname: Elmorshedi
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel Wahab
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Sultan
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Elghawalby
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Elshobari
authors.affiliation: Department of Hepatology, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elsadany
authors.affiliation: Department of Pathology, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: Zalata
authors.affiliation: Department of Radiology, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
authors.forename: Usama
authors.initials: U
authors.lastname: Shiha
mesh_terms: D000328:Adult; D001794:Blood Pressure; D004311:Double-Blind Method; D005260:Female; D005947:Glucose; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions; D011169:Portal Vein; D011189:Potassium Chloride; D011343:Procaine; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D055815:Young Adult
chemical_list: C039984:Bretschneider cardioplegic solution; D019188:Organ Preservation Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose
keywords: graft flushing; graft rinse; ischemia/reperfusion injury; postreperfusion syndrome; preservative solution