Technical Aspects of Orthotopic Liver Transplantation—a Survey-Based Study Within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks
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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.
KeywordsSurvey 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
Portal vein first reperfusion
Randomized controlled trial
Side-to-side duct-to-duct anastomosis
Total caval replacement
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.
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.
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