The Effect of Surgical Technique and Portal Hypertension on Operative Blood Loss in Recipients Receiving Liver Transplantation

Background: Liver cirrhosis can cause Portal Hypertension (PH) by increased intrahepatic vascular resistance. Recipients with PH have an increased perioperative bleeding risk in orthotopic Liver Transplantation (LT). Temporary Portocaval Shunts (TPCS) and initial Arterial Reperfusion (IAR) have been introduced as techniques to reduce perioperative blood loss in LT. However, the beneficial effect of both techniques is still controversial and little is known about the use of both techniques in recipients with versus without PH. The aim of this study was to evaluate the effect of a TPCS and IAR in LT on peroperative blood loss in patients with PH (PH group) and without PH (no-PH group). Methods: Peroperative transfusion requirement of packed Red Blood Cells (RBC) was used as a surrogate marker for peroperative blood loss. Between January 2005 and May 2017 all orthotopic, first LTs (n=214) performed in a single center were retrospectively analyzed. Results: Multivariate analysis in the no-PH group showed that using a TPCS significantly decreased peroperative blood loss (p=0.01). Instead, in the PH group, using IAR significantly decreased peroperative blood loss (p<0.001). Conclusion: Using IAR in LT significantly decreases peroperative blood loss in recipients with PH, whereas in recipients without PH a TPCS leads to significantly less peroperative blood loss. Therefore, the use of these techniques, potentially both or depending on presence of PH could be considered in patients receiving LT.