Prolonged hepatic inflow occlusion to reduce bleeding during recipient hepatectomy in living donor liver transplantation

• Published in: Clinical transplantation and research 2020, 34(1), 79, pp.55-61
• Main Authors: Choi, Jin-Uk, Hwang, Shin, Chung, I-Ji, Kang, Sang-Hyun, Ahn, Chul-Soo, Moon, Deok-Bog, Ha, Tae-Yong, Kim, Ki-Hun, Song, Gi-Won, Jung, Dong-Hwan, Park, Gil-Chun, Yoon, Young-In, Cho, Hui-Dong, Lee, Sung-Gyu
• Format: Article
• Language: English
• Subjects: living donor liver transplantation; bleeding; pringle maneuver; portal hypertension; Original; 의학일반
• ISSN: 2671-8790; 3022-6783; 2671-8804; 3022-7712
• DOI: 10.4285/kjt.2020.34.1.55

Background : Living donor liver transplantation (LDLT) causes bleeding in recipients during the careful preservation of most perihilar structures during this surgery. This case-control study aimed to analyze the effect of prolonged hepatic inflow occlusion (PHIO) when applied during recipient hepatectomy in LDLT. Methods : The study group comprised patients who underwent PHIO with Model for End-Stage Liver Disease (MELD) scores ranging from 26 to 35 (n=20). The following two control groups were selected according to their MELD scores: the low-MELD score group (MELD scores of 15-20, n=40) and the high-MELD score group (MELD scores of 26-35, n=40). Total dissection time for hepatic mobilization and dissection and blood loss during these procedures were compared between the two groups. Results : In the PHIO study group, mean total dissection time and mean PHIO duration were 226.3±59.4 and 68.2±19.1 minutes, respectively. Twelve patients underwent PHIO twice, and the other eight patients underwent PHIO once. The low-MELD score control group and the PHIO study group showed similar dissection duration (216.0±43.9 vs. 226.3±59.4 minutes, P=0.82) and similar blood loss volume during dissection (2,112.5±1,614.9 vs. 2,350.0±951.9 mL, P=0.17). The high-MELD score control group and the PHIO study group showed similar dissection duration (241.0±41.9 vs. 226.3±59.4 minutes, P=0.71), but the PHIO group showed a significantly lower blood loss during dissection than the high-MELD score group (2,350.0±951.9 vs. 2,815.0±1,813.9 mL, P=0.002). During and after PHIO, no adverse complication was observed, except for transient splanchnic congestion. Conclusions: Our findings suggest that PHIO is a simple effective method to reduce intraoperative bleeding during hepatic mobilization and dissection during LDLT operation requiring difficult dissection.