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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

Gradient between the free hepatic vein pressure and the central venous pressure (FHVP-CVP).Large symbols represent mean FHVP-CVP gradient values and bars represent standard deviation. Small symbols represent individual FHVP-CVP gradient values. Median FHVP-CPV gradients are similar in conventional and piggyback techniques (p = 0.74). In the piggyback group, four variants of hepatic venous outflow reconstruction were used: anastomosis to the cuff of the middle and left hepatic veins (grey square); to the right and middle hepatic veins (grey diamond); to the right, middle and left hepatic veins (black diamond); and side-to-side anastomosis between graft’s and recipient’s vena cava (black square). ANOVA comparison showed a significant difference between these 4 reconstructions (p = 0.04).
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pone.0129923.g002: Gradient between the free hepatic vein pressure and the central venous pressure (FHVP-CVP).Large symbols represent mean FHVP-CVP gradient values and bars represent standard deviation. Small symbols represent individual FHVP-CVP gradient values. Median FHVP-CPV gradients are similar in conventional and piggyback techniques (p = 0.74). In the piggyback group, four variants of hepatic venous outflow reconstruction were used: anastomosis to the cuff of the middle and left hepatic veins (grey square); to the right and middle hepatic veins (grey diamond); to the right, middle and left hepatic veins (black diamond); and side-to-side anastomosis between graft’s and recipient’s vena cava (black square). ANOVA comparison showed a significant difference between these 4 reconstructions (p = 0.04).

Mentions: Hepatic vein and right atrium pressure measurements were performed 174.0 ± 87.1 minutes after graft revascularization, on average. The observed FHVP-CVP gradient values in the conventional and piggyback groups are shown in Fig 2. Mean gradient value was 2.43 ± 2.68 vs. 2.41 ± 1.94 mm Hg, respectively. Median FHVP-CVP gradient value is 2 mm Hg in the conventional group (range 0–8 mm Hg) and 3 mm Hg, in the piggyback group (range 0–7 mm Hg). This difference was not statistically significant (p = 0.73). A FHVP-CVP gradient higher than 3 mm Hg was observed in 26.7% of the cases (4/15) in the conventional and in 17.6% of the cases (3/17) in the piggyback group. There is no statistically significant difference between these rates (p = 0.68).


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)

Gradient between the free hepatic vein pressure and the central venous pressure (FHVP-CVP).Large symbols represent mean FHVP-CVP gradient values and bars represent standard deviation. Small symbols represent individual FHVP-CVP gradient values. Median FHVP-CPV gradients are similar in conventional and piggyback techniques (p = 0.74). In the piggyback group, four variants of hepatic venous outflow reconstruction were used: anastomosis to the cuff of the middle and left hepatic veins (grey square); to the right and middle hepatic veins (grey diamond); to the right, middle and left hepatic veins (black diamond); and side-to-side anastomosis between graft’s and recipient’s vena cava (black square). ANOVA comparison showed a significant difference between these 4 reconstructions (p = 0.04).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0129923.g002: Gradient between the free hepatic vein pressure and the central venous pressure (FHVP-CVP).Large symbols represent mean FHVP-CVP gradient values and bars represent standard deviation. Small symbols represent individual FHVP-CVP gradient values. Median FHVP-CPV gradients are similar in conventional and piggyback techniques (p = 0.74). In the piggyback group, four variants of hepatic venous outflow reconstruction were used: anastomosis to the cuff of the middle and left hepatic veins (grey square); to the right and middle hepatic veins (grey diamond); to the right, middle and left hepatic veins (black diamond); and side-to-side anastomosis between graft’s and recipient’s vena cava (black square). ANOVA comparison showed a significant difference between these 4 reconstructions (p = 0.04).
Mentions: Hepatic vein and right atrium pressure measurements were performed 174.0 ± 87.1 minutes after graft revascularization, on average. The observed FHVP-CVP gradient values in the conventional and piggyback groups are shown in Fig 2. Mean gradient value was 2.43 ± 2.68 vs. 2.41 ± 1.94 mm Hg, respectively. Median FHVP-CVP gradient value is 2 mm Hg in the conventional group (range 0–8 mm Hg) and 3 mm Hg, in the piggyback group (range 0–7 mm Hg). This difference was not statistically significant (p = 0.73). A FHVP-CVP gradient higher than 3 mm Hg was observed in 26.7% of the cases (4/15) in the conventional and in 17.6% of the cases (3/17) in the piggyback group. There is no statistically significant difference between these rates (p = 0.68).

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