10. Effect of portal hypertension and surgical technique on perioperative blood loss in liver transplantation

L.C. Pietersen, E. Sarton, C.S.P. van Rijswijk, M. Tushuizen, H. Putter, H.D. Lam, A.G. Baranski, I.P.J. Alwayn, A.E. Braat, B. van Hoek

Wednesday 4 march 2020

0:00 - 0:00h at Toon Hermans Foyer

Parallel session: Postersessie 3 – Klinische abstracts

Background: Liver cirrhosis can cause portal hypertension (PH) by increased intrahepatic vascular resistance and therefore increased perioperative bleeding risk. The hepatic venous pressure gradient (HVPG) is the gold standard for measuring PH. In orthotopic liver transplantation (LT), the beneficial use of a temporary portocaval shunt (TPCS) and initial arterial reperfusion (IAR) is contradictory. The aim of this study was to evaluate the effect of TPCS and IAR on perioperative transfusion requirement of packed red blood cells (RBC) in patients with PH (PH group) and without PH (no-PH group).

Methods: Between January 2005 and May 2017 all orthotopic, first LTs (n=214) performed in a single center were retrospectively analyzed. A multivariate analysis was performed to determine the predictors for blood loss.

Results: A TPCS decreased significantly the number of transfusion of RBCs (p=0.01) in the no-PH group, while IAR decreases the number of transfusion of RBCs (p<0.001) in the PH group. In conclusion, in patients without PH, a TPCS results in less perioperative transfusion of RBCs, whereas in patients with PH, IAR results in less perioperative transfusion of RBCs.

Conclusions: These surgical techniques, on indication or combined, should be considered as surgical options in LT.