Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis

Michel Rayar (1, 2) , Giovanni B. Levi Sandri (1) , Caterina Cusumano (1) , Clara Locher (3, 2, 1) , Pauline Houssel-Debry (2, 3) , Christophe Camus (2, 3) , Nicolas Lombard (1) , Véronique Desfourneaux (1, 3) , Mohamed Lakehal (1) , B. Meunier (1) , Laurent Sulpice (1, 2, 4) , Karim Boudjema (1, 2, 4)

1 Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 Foie, métabolismes et cancer

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.

Domaines: Hépatologie et Gastroentérologie; Chirurgie; Cancer

Michel Rayar, Giovanni B. Levi Sandri, Caterina Cusumano, Clara Locher, Pauline Houssel-Debry, et al.. Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis. Liver Transplantation, 2017, 23 (2), pp.174-183. ⟨10.1002/lt.24650⟩. ⟨hal-01447066⟩