Temporary Intraoperative Porto-Caval Shunts in Piggy-Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta-Analysis

• Published in: World journal of surgery 2016-12, Vol.40 (12), p.2988-2998
• Main Authors: Pratschke, Sebastian, Rauch, Alexandra, Albertsmeier, Markus, Rentsch, Markus, Kirschneck, Michaela, Andrassy, Joachim, Thomas, Michael, Hartwig, Werner, Figueras, Joan, Del Rio Martin, Juan, De Ruvo, Nicola, Werner, Jens, Guba, Markus, Weniger, Maximilian, Angele, Martin K.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aspartate Aminotransferases - blood; Blood Loss, Surgical - prevention & control; Cardiac Surgery; Erythrocyte Transfusion; Fresh Freeze Plasma; General Surgery; Humans; Inferior Vena Cava; Intraoperative Care - methods; Kidney - physiology; Length of Stay; Liver Transplantation; Liver Transplantation - methods; Medicine; Medicine & Public Health; Meld Score; Original Scientific Report; Portacaval Shunt, Surgical; Portal Venous Flow; Postoperative Period; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3656-1

Background The value of temporary intraoperative porto-caval shunts (TPCS) in cava-sparing liver transplantation is discussed controversially. Aim of this meta-analysis was to analyze the impact of temporary intraoperative porto-caval shunts on liver injury, primary non-function, time of surgery, transfusion of blood products and length of hospital stay in cava-sparing liver transplantation. Methods A systematic search of MEDLINE/PubMed, EMBASE and PsycINFO retrieved a total of 909 articles, of which six articles were included. The combined effect size and 95 % confidence interval were calculated for each outcome by applying the inverse variance weighting method. Tests for heterogeneity ( I 2 ) were also utilized. Results Usage of a TPCS was associated with significantly decreased AST values, significantly fewer transfusions of packed red blood cells and improved postoperative renal function. There were no statistically significant differences in primary graft non-function, length of hospital stay or duration of surgery. Conclusion This meta-analysis found that temporary intraoperative porto-caval shunts in cava-sparing liver transplantation reduce blood loss as well as hepatic injury and enhance postoperative renal function without prolonging operative time. Randomized controlled trials investigating the use of temporary intraoperative porto-caval shunts are needed to confirm these findings.