Retrograde Reperfusion Versus Antegrade Liver Transplant Reperfusion

Study Overview
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Brief Summary
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A retrospective cohort analysis was performed comparing patients that had intra operative antegrade liver reperfusions versus patients that had retrograde liver perfusion.

Detailed Description
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A retrospective cohort analysis was performed comparing patients that had intra operative antegrade liver reperfusions versus patients that had retrograde liver perfusion. Antegrade Reperfusion(ATR) group: after completing the caval replacement or piggy-back, for IVC anastomosis, Portal vein (PV) anastomosis was done with a running suture as normal fashion, then it was followed by the removal the clamps, starting by the supra hepatic VC, followed by the PV clamp and finally the infrahepatic VC. It was followed by arterial anastomosis and the biliary anastomosis (duct-to-duct if possible). Retrograde group (RETR): after completing the piggyback the IVC was declamped immediately and retrograde low pressure reperfusion of the graft with low oxygenated venous blood was established. Central venous pressure was intended to be higher than in 8 mmHg to enable appropriate retrograde reperfusion in the transplanted liver. Significant venous backflow via portal vein appears immediately after declamping. Venous bleeding from the liver except portal backflow was stopped immediately after declamping the venous anastomosis, as appropriate. Portal vein anastomosis was performed using running suture. It was followed by arterial anastomosis and the biliary anastomosis (duct-to-duct if possible). The endpoints are patient survival and graft survival at 1, 3,5, 10 years post liver transplantation in both groups. To adjust for a selection bias, we will perform a propensity score analysis.

Official Title
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A Propensity Score Matched Pair Analysis of Retrograde Reperfusion Versus Antegrade Liver Transplant Reperfusion

Conditions
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Liver Transplant Failure

Intervention / Treatment
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* Procedure: Graft reperfusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all liver transplantations between 1 Jan 2002 and 31 Dec 2005 Exclusion Criteria: liver retransplantation multiorgan transplantation ABO incompatible transplantation

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Retrograde reperfusion<br>After completion of the inferior vena cava anastomosis, the clamps were removed to allow retrograde reperfusion of the graft. | Procedure: Graft reperfusion<br>* antegrade (forward) or retrograde (backward) blood reperfusion of the liver graft<br>|
| Antegrade reperfusion<br>After completion of the inferior vena cava anastomosis, the portal vein anastomosis is completed and then the clamps were removed to allow antegrade reperfusion of the graft. | Procedure: Graft reperfusion<br>* antegrade (forward) or retrograde (backward) blood reperfusion of the liver graft<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Graft survival | Average length of time the liver graft remains in a living recipient regardless of function | From date of transplantation until the date of next transplantation or date of death from any cause, whichever came first, assessed up to 300 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient survival | Average length of time a recipient is alive regardless of presence of the second liver | From date of transplantation until the date of death from any cause assessed up to 300 months |