Phase I clinical trial of the feasibility and safety of direct peritoneal resuscitation in liver transplantation

• Published in: The American journal of surgery 2024-12, Vol.238, p.115815, Article 115815
• Main Authors: Rodriguez, Ivan E., Asher, Zachary P., Klingenberg, Katherine, Wright, Franklin L., Nydam, Trevor L., Adams, Megan A., Bababekov, Yanik J., Peltz, Eric, Smith, Jason W., Saben, Jessica L., Kennealey, Peter, Pomposelli, James J., Pomfret, Elizabeth A., Moore, Hunter B.
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Aged; Animal models; Blood & organ donations; Clinical trials; Compartment syndrome; Criteria; Decision making; Direct peritoneal resuscitation; Edema; Enrollments; Feasibility Studies; Female; Graft loss; Hematoma; Humans; Infection; Intensive care; Intervention; Kidney transplantation; Liver; Liver diseases; Liver transplant; Liver Transplantation; Liver transplants; Male; Middle Aged; Obesity; Obesity - complications; Patients; Peritoneum; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Renal function; Resuscitation; Resuscitation - methods; Return to operating room; Risk factors; Sepsis; Standard of care; Surgeons; Surgery; Transplantation; Trauma; Treatment Outcome
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115815

Direct peritoneal resuscitation (DPR) is associated with improved outcomes in trauma. Animal models suggest DPR has favorable effects on the liver. We sought to evaluate its safety and assess for improved outcomes in liver transplantation (LT). LT patients with renal dysfunction and/or obesity were enrolled in a phase-I clinical trial. DPR lasted 8–24 ​h depending on postoperative disposition. Primary outcome was percent of patients completing DPR. Secondary outcomes evaluated complications. Controls with either obesity (control-1) or both risk factors (obesity ​+ ​renal dysfunction, control-2) were analyzed. Fifteen patients were enrolled (seven with both criteria and eight with obesity alone). DPR was completed in 87 ​% of patients, with one meeting stopping criteria. Controls included 45 (control-1) and 24 (control-2) patients. Return to operating room, graft loss, and late infections were lower with DPR. DPR appears to be safe in closed abdomens following LT, warranting a follow-up phase-II trial to assess efficacy. [Display omitted] •Direct peritoneal resuscitation was utilized high risk patients following liver transplant.•Direct peritoneal resuscitation appears to be a safe and feasible intervention in liver transplant recipients with temporary and definitively closed abdomens.•There may be some potential benefits of utilizing direct peritoneal resuscitation in individuals with obesity and renal dysfunction undergoing liver transplantation.•A phase II clinical trial is warranted to evaluate the efficacy and potential benefits of direct peritoneal resuscitation.