D-H Jung1, S Hwang1, C-S Ahn1, K-H Kim1, D-B Moon1, T-Y Ha1, G-W Song1, G C Park1, S-G Lee2. 1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: sglee2@amc.seoul.kr.
Abstract
BACKGROUND: For deceased-donor liver graft retrieval, the warm dissection technique of hilar dissection before perfusion had been the standard procedure in the early period of liver transplantation. Thereafter, the cold dissection technique of in situ flushing and hilar dissection after perfusion has been preferred in many transplantation centers for rapid procurement of multiple organs. This study intended to assess the safety and usefulness of the warm dissection technique used in deceased-donor liver transplantation. METHODS: This study analyzed a single surgeon's experience of the warm dissection technique for 165 cases of liver graft retrieval, regarding the prolongation of retrieval operation time, retrieval-associated graft injury, and recipient outcomes. RESULTS: An additional 20 to 40 minutes was required for warm dissection. The incidence of retrieval-associated graft injury was 13 (7.9%), in which hepatic parenchymal injury was detected in 7 (capsular tear in 6 and subcapsular hematoma in 1) and vascular injury in 6 (celiac axis injury in 5 and common hepatic artery injury in 1). There was no other episode of injury at the branch artery, vena cava, portal vein, and bile duct. There was no significant difference of 1-year graft survival rates between liver grafts with and without graft injury (83% vs 83.3%, P = .73). CONCLUSIONS: When the vital signs of deceased donor are stable, the warm dissection technique may be helpful to decrease the cold ischemic preservation time because the risk of graft injury is acceptably low and it provides more time for recipient preparation, thus giving potential advantages for marginal liver grafts.
BACKGROUND: For deceased-donor liver graft retrieval, the warm dissection technique of hilar dissection before perfusion had been the standard procedure in the early period of liver transplantation. Thereafter, the cold dissection technique of in situ flushing and hilar dissection after perfusion has been preferred in many transplantation centers for rapid procurement of multiple organs. This study intended to assess the safety and usefulness of the warm dissection technique used in deceased-donor liver transplantation. METHODS: This study analyzed a single surgeon's experience of the warm dissection technique for 165 cases of liver graft retrieval, regarding the prolongation of retrieval operation time, retrieval-associated graft injury, and recipient outcomes. RESULTS: An additional 20 to 40 minutes was required for warm dissection. The incidence of retrieval-associated graft injury was 13 (7.9%), in which hepatic parenchymal injury was detected in 7 (capsular tear in 6 and subcapsular hematoma in 1) and vascular injury in 6 (celiac axis injury in 5 and common hepatic artery injury in 1). There was no other episode of injury at the branch artery, vena cava, portal vein, and bile duct. There was no significant difference of 1-year graft survival rates between liver grafts with and without graft injury (83% vs 83.3%, P = .73). CONCLUSIONS: When the vital signs of deceased donor are stable, the warm dissection technique may be helpful to decrease the cold ischemic preservation time because the risk of graft injury is acceptably low and it provides more time for recipient preparation, thus giving potential advantages for marginal liver grafts.
Authors: Thanh Khiem Nguyen; Hong Son Trinh; Tuan Hiep Luong; Viet Khai Ninh; Gia Anh Pham; Ham Hoi Nguyen; Trung Nghia Bui; Kim Khue Dang; Tuan Hoang; Quang Nghia Nguyen Journal: Ann Med Surg (Lond) Date: 2021-07-31