Technical Aspects of Orthotopic Liver Transplantation-a Survey-Based Study Within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks.

Czigany, Zoltan;Scherer, Marcus N;Pratschke, Johann;Guba, Markus;Lurje, Georg;et.al.
(2019) Journal of Gastrointestinal Surgery — Vol. 23, n° 3, p. 529-537 (2019)

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Authors
  • Czigany, Zoltan
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  • Scherer, Marcus N
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  • Pratschke, Johann
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  • Guba, Markus
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  • Lerut, JanUCLouvain
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  • Lurje, Georgorcid-logo
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Abstract
(en) BACKGROUND: Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. However, technical aspects of OLT are still subject of ongoing debate and are widely based on personal experience and local institutional protocols. METHODS: An international online survey was sent out to all liver transplant centers (n = 52) within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplant Society networks. The survey sought information on center-specific OLT caseload, vascular and biliary reconstruction, graft reperfusion, intraoperative control of hemodynamics, and drain policies. RESULTS: Forty-two centers gave a valid response (81%). Out of these, 50% reported piggy-back and 40.5% total caval replacement as their standard technique. While 48% of all centers generally do not apply veno-venous bypass (vvBP) or temporary portocaval shunt (PCS) during OLT, vvBP/PCS are routinely used in six centers (14%). Portal vein first reperfusion is used in 64%, followed by simultaneous (17%), and retrograde reperfusion (12%). End-to-end duct-to-duct anastomosis without biliary drain (67%) is the most frequently performed method of biliary reconstruction. No significant associations were found between the center caseload and the surgical approach used. The predominant part of the centers (88%) stated that techniques of OLT are not evidence-based and 98% would participate in multicenter clinical trials on these topics. CONCLUSION: Technical aspects of OLT vary widely among European centers. The extent to which center-specific variation of techniques affect transplant outcomes in Europe should be elucidated further in prospective multicenter trials.
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Czigany, Z., Scherer, M. N., Pratschke, J., Guba, M., Nadalin, S., Mehrabi, A., Berlakovich, G., Rogiers, X., Pirenne, J., Lerut, J., Mathe, Z., Dutkowski, P., Ericzon, B.-G., Malagó, M., Heaton, N., Schöning, W., Bednarsch, J., Neumann, U. P., & Lurje, G. (2019). Technical Aspects of Orthotopic Liver Transplantation-a Survey-Based Study Within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks. Journal of Gastrointestinal Surgery, 23(3), 529-537. https://doi.org/10.1007/s11605-018-3915-6 (Original work published 2019)