Randomized controlled trial to evaluate flush and reperfusion techniques in liver transplantation

Area of Science:

• Transplantation surgery
• Hepatobiliary surgery
• Organ preservation

Background:

• Postreperfusion syndrome (PRS) is a common complication following liver transplantation.
• Optimizing flush and reperfusion techniques is crucial for improving patient outcomes and graft survival.

Purpose of the Study:

• To evaluate the impact of different flush and reperfusion strategies on the incidence of PRS.
• To assess the effect of these techniques on early postoperative graft function.

Main Methods:

• 100 liver transplants were randomized into four groups based on flush (portal vein vs. hepatic artery) and vena caval venting (present vs. absent).
• Intraoperative and postoperative hemodynamic parameters, including mean arterial pressure (MAP), were monitored extensively.
• PRS was defined by specific MAP criteria within the first 5 minutes postreperfusion.

Main Results:

• Portal vein flush without vena caval venting (Group 1) demonstrated the lowest incidence of PRS compared to other techniques.
• Vena caval venting in Groups 3 and 4 significantly reduced serum potassium increases postreperfusion.
• No significant differences in overall hemodynamic or biochemical changes, or postoperative graft function, were observed among the four groups by 30 minutes postreperfusion.

Conclusions:

• Portal vein flush without vena caval venting is the most effective technique for minimizing PRS during liver transplantation.
• Vena caval venting effectively mitigates potassium release but does not influence overall graft outcomes.
• Flush and reperfusion techniques have a limited impact on early postoperative graft function.