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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

Mean serum creatinine (Cr) values from the preoperative period till the 28th postoperative day.Bars represent standard error. The 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).
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pone.0129923.g003: Mean serum creatinine (Cr) values from the preoperative period till the 28th postoperative day.Bars represent standard error. The 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).

Mentions: Fig 3 shows the distribution of the mean Cr values from the preoperative period till the 28th PO in both groups. Fig 4 shows the prevalence of ARF according to RIFLE-AKIN staging in conventional and piggyback groups up to the 28th PO. Based on the QIC values, GEE analysis of Cr longitudinal measurements was performed assuming exchangeable correlation while a nine-dependent working correlation structure was preferred for ARF assessment. 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 significantly higher prevalence of severe ARF on the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048).


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)

Mean serum creatinine (Cr) values from the preoperative period till the 28th postoperative day.Bars represent standard error. The 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).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0129923.g003: Mean serum creatinine (Cr) values from the preoperative period till the 28th postoperative day.Bars represent standard error. The 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).
Mentions: Fig 3 shows the distribution of the mean Cr values from the preoperative period till the 28th PO in both groups. Fig 4 shows the prevalence of ARF according to RIFLE-AKIN staging in conventional and piggyback groups up to the 28th PO. Based on the QIC values, GEE analysis of Cr longitudinal measurements was performed assuming exchangeable correlation while a nine-dependent working correlation structure was preferred for ARF assessment. 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 significantly higher prevalence of severe ARF on the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048).

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