Journal of Gastrointestinal Surgery

, Volume 23, Issue 3, pp 529–537 | Cite as

Technical Aspects of Orthotopic Liver Transplantation—a Survey-Based Study Within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks

  • Zoltan Czigany
  • Marcus N. Scherer
  • Johann Pratschke
  • Markus Guba
  • Silvio Nadalin
  • Arianeb Mehrabi
  • Gabriela Berlakovich
  • Xavier Rogiers
  • Jacques Pirenne
  • Jan Lerut
  • Zoltan Mathe
  • Philipp Dutkowski
  • Bo-Göran Ericzon
  • Massimo Malagó
  • Nigel Heaton
  • Wenzel Schöning
  • Jan Bednarsch
  • Ulf Peter Neumann
  • Georg LurjeEmail author
Original Article



Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. However, technical aspects of OLT are still subject of ongoing debate and are widely based on personal experience and local institutional protocols.


An international online survey was sent out to all liver transplant centers (n = 52) within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplant Society networks. The survey sought information on center-specific OLT caseload, vascular and biliary reconstruction, graft reperfusion, intraoperative control of hemodynamics, and drain policies.


Forty-two centers gave a valid response (81%). Out of these, 50% reported piggy-back and 40.5% total caval replacement as their standard technique. While 48% of all centers generally do not apply veno-venous bypass (vvBP) or temporary portocaval shunt (PCS) during OLT, vvBP/PCS are routinely used in six centers (14%). Portal vein first reperfusion is used in 64%, followed by simultaneous (17%), and retrograde reperfusion (12%). End-to-end duct-to-duct anastomosis without biliary drain (67%) is the most frequently performed method of biliary reconstruction. No significant associations were found between the center caseload and the surgical approach used. The predominant part of the centers (88%) stated that techniques of OLT are not evidence-based and 98% would participate in multicenter clinical trials on these topics.


Technical aspects of OLT vary widely among European centers. The extent to which center-specific variation of techniques affect transplant outcomes in Europe should be elucidated further in prospective multicenter trials.


Survey Liver transplantation Piggy-back Reperfusion Abdominal drain 



Artery first reperfusion


British Transplant Society


Donation following cardiac death


Extended criteria donors


End-to-end duct-to-duct anastomosis




Model for End-stage Liver Disease


Orthotopic liver transplantation




Portocaval shunt


Portal vein first reperfusion


Randomized controlled trial


Retrograde reperfusion




Simultaneous reperfusion


Side-to-side duct-to-duct anastomosis




Total caval replacement


Veno-venous bypass


Warm ischemia time



The authors would like to thank the responsible boards of the ET, BTS, ST, and ScaT for their support and Dr. Marieke van Rosmalen (ET) for her kind assistance.

Authors’ Contribution

The study was designed and the survey was distributed by the initiating study team (ZC, UPN, JB, GL). Data collection and analysis was performed by ZC, UPN, JB, and GL. Initial manuscript was drafted by ZC, GL, JB, UPN, and MNS. Further authors (JP, MG, SN, AM, GB, XR, JP, JL, ZM, PD, BE, MM, NH, WS) have substantially contributed to the final version of the manuscript. All authors have read and approved the final version of the manuscript.


This research project is supported by the START-Program (No. 136/17) of the Faculty of Medicine, RWTH Aachen, and funded by the Excellence Initiative of the German federal and state governments (G:(DE-82) ZUK2-SF-OPSF443).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11605_2018_3915_MOESM1_ESM.pdf (50 kb)
ESM 1 (PDF 50 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Zoltan Czigany
    • 1
  • Marcus N. Scherer
    • 2
  • Johann Pratschke
    • 3
  • Markus Guba
    • 4
  • Silvio Nadalin
    • 5
  • Arianeb Mehrabi
    • 6
  • Gabriela Berlakovich
    • 7
  • Xavier Rogiers
    • 8
  • Jacques Pirenne
    • 9
  • Jan Lerut
    • 10
  • Zoltan Mathe
    • 11
  • Philipp Dutkowski
    • 12
  • Bo-Göran Ericzon
    • 13
  • Massimo Malagó
    • 14
  • Nigel Heaton
    • 15
  • Wenzel Schöning
    • 1
  • Jan Bednarsch
    • 1
  • Ulf Peter Neumann
    • 1
  • Georg Lurje
    • 1
    Email author
  1. 1.Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
  2. 2.Department of Surgery and TransplantationUniversity Hospital RegensburgRegensburgGermany
  3. 3.Department of Surgery and TransplantationUniversity Hospital Berlin - CharitéBerlinGermany
  4. 4.Department of SurgeryUniversity Hospital MunichMunichGermany
  5. 5.Department of Surgery and TransplantationUniversity Hospital TuebingenTuebingenGermany
  6. 6.Department of General, Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany
  7. 7.Department of Surgery, Division of TransplantationMedical University of ViennaViennaAustria
  8. 8.Department of Solid Organ TransplantationUniversity Hospital GentGhentBelgium
  9. 9.Department of Hepatobiliary Surgery and TransplantationUniversity Hospital LeuvenLeuvenBelgium
  10. 10.Unit of Liver Transplantation and General SurgeryUniversity Hospitals St.-LucBrusselsBelgium
  11. 11.Department of Surgery and TransplantationSemmelweis UniversityBudapestHungary
  12. 12.Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
  13. 13.Department of Solid Organ TransplantationUniversity Hospital Stockholm - Karolinska InstituteStockholmSweden
  14. 14.Department of Hepatobiliary Surgery and TransplantationUniversity College LondonLondonUK
  15. 15.Department of Hepatobiliary Surgery and TransplantationKing’s College HospitalLondonUK

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