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KMID : 0361120200340010055
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Korean Journal of Transplantation
2020 Volume.34 No. 1 p.55 ~ p.61
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Prolonged hepatic inflow occlusion to reduce bleeding during recipient hepatectomy in living donor liver transplantation
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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
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Abstract
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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.
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KEYWORD
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Living donor liver transplantation, Bleeding, Pringle maneuver, Portal hypertension
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