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Antegrade Arterial and Portal Flushing Versus Portal Flushing Only for Right Lobe Live Donor Liver Transplantation—A Randomized Control Trial

Pamecha, Viniyendra, FEBS, FRCS(UK)1; Sandhyav, Rommel, MCh, HPB1; Sinha, Piyush, Kumar, MCh, HPB1; Bharathy, Kishore Gurumoorthy, Subramanya, MCh, M. HPB1; Sasturkar, Shridhar, MCh, HPB1

doi: 10.1097/TP.0000000000002088
Original Clinical Science—Liver
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Background In live donor liver transplantation portal flush only of the graft is done on the bench. There are no data on antegrade arterial flush along with portal flush of the graft.

Methods Consecutive patients undergoing elective right lobe live donor liver transplantation were block-randomized to receive either portal flush only or both portal and antegrade arterial flush. The primary objectives were safety, rate of early allograft dysfunction (EAD), and impact on vascular and biliary complications.

Results After randomization, there were 40 patients in each group. Both groups had comparable preoperative, intraoperative, and donor variables. There were no adverse events related to arterial flushing. The portal and antegrade arterial flush group had significantly lower postoperative bilirubin on days 7, 14, and 21 (all P < 0.05), EAD (P = 0.005), intensive care unit/high dependency unit (P = 0.01), and hospital stay (P = 0.05). This group also had lower peak aspartate aminotransferase (P = 0.07), alanine aminotransferase (P = 0.06) and lower rates of sepsis (P = 0.08) trending toward statistical significance. Portal and antegrade arterial flush groups had lower ascitic fluid drainage and in-hospital mortality. Arterial and biliary complications were not statistically different in the 2 groups. Multivariate analysis of EAD showed portal with antegrade arterial flush was associated with lower rate (P = 0.007), whereas model for end-stage liver disease Na (P = 0.01) and donor age (P = 0.03) were associated with a higher rate of EAD.

Conclusions Portal with antegrade arterial flushing of right lobe live liver grafts is safe, significantly decreases postoperative cholestasis, EAD, intensive care unit/high dependency unit, and hospital stay and is associated with lower rates of sepsis, ascitic drainage and inhospital mortality in comparison to portal flush only.

The authors conduct a randomized trial suggesting that antegrade perfusion of living donor liver grafts can improve perfusion and outcomes

1 Department of Liver Transplant and Hepato Pancreato Biliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.

Received 24 August 2017. Revision received 22 November 2017.

Accepted 2 December 2017.

The authors declare no funding or conflicts of interest.

Trial registration no. NCT03048318 Clinicaltrials.gov.

V.P. participated in the study conception. R.S. participated in the data collection. R.S., P.K.S., S.S., K.G.S.B., V.P. participated in the article drafting. V.P. participated in the critical revision of the article for important intellectual content.

Correspondence: Viniyendra Pamecha, MS, MRCS, FEBS, FRCS, Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences, New Delhi, India. (viniyendra@yahoo.co.uk).

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