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Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation.

Brescia MD, Massarollo PC, Imakuma ES, Mies S - PLoS ONE (2015)

Bottom Line: There is no statistically significant difference between the conventional (1/15) and the piggyback (2/17) groups regarding massive ascites development (p = 1.00).GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02).Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft.

View Article: PubMed Central - PubMed

Affiliation: Laboratório de Anatomia Médico-Cirúrgica (LIM-02), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT

Background: This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15) or piggyback (n = 17) liver transplantation.

Methods: Free hepatic vein pressure (FHVP) and central venous pressure (CVP) measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr) was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO). The prevalence of acute renal failure (ARF) up to the 28th PO was analyzed by RIFLE-AKIN criteria. A Generalized Estimating Equation (GEE) approach was used for comparison of longitudinal measurements of renal function.

Results: FHVP-CVP gradient > 3 mm Hg was observed in 26.7% (4/15) of the patients in the conventional group and in 17.6% (3/17) in the piggyback group (p = 0.68). Median FHVP-CVP gradient was 2 mm Hg (0-8 mmHg) vs. 3 mm Hg (0-7 mm Hg) in conventional and piggyback groups, respectively (p = 0.73). There is no statistically significant difference between the conventional (1/15) and the piggyback (2/17) groups regarding massive ascites development (p = 1.00). GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02). The conventional method presented a higher prevalence of severe ARF during the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048).

Conclusion: Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft. Conventional with venovenous bypass technique significantly increases the harm of postoperative renal dysfunction.

Trial registration: ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01707810.

No MeSH data available.


Related in: MedlinePlus

Chart showing the flow of patients during the stages of eligibility, assessment, enrollment and allocation.
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pone.0129923.g001: Chart showing the flow of patients during the stages of eligibility, assessment, enrollment and allocation.

Mentions: Fig 1 summarizes the flow of patients during the stages of eligibility assessment, enrollment and allocation. Sixty-four LTx were performed during the period of enrollment. Of these, nineteen cases did not satisfy the inclusion criteria and were considered ineligible (Table 1). Other three patients refused to participate in the study. The remaining forty-two patients who agreed to participate were randomized immediately before surgery. However, ten cases (5 from conventional and 5 from piggyback group) were excluded after randomization: four because of displacement of the catheter from right hepatic vein (two patients from each surgical group); two, in whom the surgical method predicted by randomization was switched during transplantation (from piggyback to conventional method in both instances); two, who died in the intraoperative period (both from conventional group); one because of hemodynamic instability (piggyback group); and one, due to missing intraoperative data (conventional group). Thus 32 cases were effectively studied, 15 of the conventional and 17 of the piggyback group. The patients’ diagnoses are shown in Table 2.


Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation.

Brescia MD, Massarollo PC, Imakuma ES, Mies S - PLoS ONE (2015)

Chart showing the flow of patients during the stages of eligibility, assessment, enrollment and allocation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482688&req=5

pone.0129923.g001: Chart showing the flow of patients during the stages of eligibility, assessment, enrollment and allocation.
Mentions: Fig 1 summarizes the flow of patients during the stages of eligibility assessment, enrollment and allocation. Sixty-four LTx were performed during the period of enrollment. Of these, nineteen cases did not satisfy the inclusion criteria and were considered ineligible (Table 1). Other three patients refused to participate in the study. The remaining forty-two patients who agreed to participate were randomized immediately before surgery. However, ten cases (5 from conventional and 5 from piggyback group) were excluded after randomization: four because of displacement of the catheter from right hepatic vein (two patients from each surgical group); two, in whom the surgical method predicted by randomization was switched during transplantation (from piggyback to conventional method in both instances); two, who died in the intraoperative period (both from conventional group); one because of hemodynamic instability (piggyback group); and one, due to missing intraoperative data (conventional group). Thus 32 cases were effectively studied, 15 of the conventional and 17 of the piggyback group. The patients’ diagnoses are shown in Table 2.

Bottom Line: There is no statistically significant difference between the conventional (1/15) and the piggyback (2/17) groups regarding massive ascites development (p = 1.00).GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02).Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft.

View Article: PubMed Central - PubMed

Affiliation: Laboratório de Anatomia Médico-Cirúrgica (LIM-02), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT

Background: This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15) or piggyback (n = 17) liver transplantation.

Methods: Free hepatic vein pressure (FHVP) and central venous pressure (CVP) measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr) was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO). The prevalence of acute renal failure (ARF) up to the 28th PO was analyzed by RIFLE-AKIN criteria. A Generalized Estimating Equation (GEE) approach was used for comparison of longitudinal measurements of renal function.

Results: FHVP-CVP gradient > 3 mm Hg was observed in 26.7% (4/15) of the patients in the conventional group and in 17.6% (3/17) in the piggyback group (p = 0.68). Median FHVP-CVP gradient was 2 mm Hg (0-8 mmHg) vs. 3 mm Hg (0-7 mm Hg) in conventional and piggyback groups, respectively (p = 0.73). There is no statistically significant difference between the conventional (1/15) and the piggyback (2/17) groups regarding massive ascites development (p = 1.00). GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02). The conventional method presented a higher prevalence of severe ARF during the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048).

Conclusion: Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft. Conventional with venovenous bypass technique significantly increases the harm of postoperative renal dysfunction.

Trial registration: ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01707810.

No MeSH data available.


Related in: MedlinePlus