Sequential or Simultaneous Portal-Arterial Reperfusion During Liver Transplantation: A Retrospective Study

Ischemia-reperfusion injury is a relevant complication in liver transplantation. Sequential (SeqR) and simultaneous reperfusion (SimR) techniques are the most commonly used strategies to reduce this injury; however, there is still no consensus regarding which technique provides better outcomes. This study compares these techniques in terms of graft recovery, complications, and patient survival.

This retrospective study included 872 patients who underwent liver transplantation, divided into 2 groups according to the reperfusion technique used. Patient characteristics, intraoperative and postoperative outcomes, as well as recipient and graft mortality and survival, were analyzed. Continuous variables were analyzed using Student's t-test, and categorical variables using Pearson's chi-square test, with a significance level of 5%.

A total of 520 transplants were performed using SimR and 352 using SeqR. SimR was associated with shorter operative time (P < .001) and longer total ischemia time (P < .001). It was also associated with a higher incidence of biliary stricture (P = .032) and a lower rate of graft rejection (95% CI: 0.342-0.754; OR: 0.508; P < .001). Overall recipient survival was significantly higher in the SimR group (P = .002).

In this study, the SimR technique was significantly associated with improved overall recipient survival, despite being associated with longer total ischemia time. SimR was also correlated with a higher incidence of biliary strictures but demonstrated a protective effect against graft rejection. These findings should be confirmed in prospective, randomized studies.