Impact of Reperfusion with Blood Venting on Outcomes of Liver Transplantation; a Prospective Case-Control Study

Post reperfusion syndrome (PRS) during liver transplantation (LT) remains a serious issue for the surgeon and anesthetist. This study aimed to evaluate the impact of two different reperfusion techniques on outcomes of LT patients.

In this prospective case-control study, liver transplant recipients were divided into two groups of vented (reperfusion with 300cc blood venting) and non-vented (reperfusion without blood venting) then30-minuteintra-operative hemodynamic and biochemical changes as well as 2- month complications and 6-month mortality were compared between the groups.

57 LT cases (31 vented and 26 non-vented) were studied (50.9% female). The two groups had similar age (p = 0.107), sex (p = 0.885), MELD score (p = 0.61), donor warm ischemic time (p = 0.85), recipient warm ischemic time (p = 0.36), cold ischemic time (p = 0.99), comorbid disease (p = 0.502), and etiology of end-stage liver disease (p = 0.281). There was no significant difference between the groups regarding mean arterial pressure (p > 0.20), mean heart rate (p > 0.39), mean systemic vascular resistance (p > 0.26), and mean cardiac output (p > 0.20). PRS occurred in 3 (11.5%) patients in vented group and 4 (12.9%) in non-vented group (p = 0.69). The frequency of primary non-function (p = 1.00), hepatic artery thrombosis (p = 1.00), portal vein thrombosis (p = 0.44), biopsy proven rejection (p = 1.00), need for dialysis (p = 1.00), biliary complications (p = 1.00), wound infection (p = 0.08), and pneumonia (p = 1.00) was same in the two groups. 1 (3.8%) patient in non-vented group and 4 (12.9%) patients in vented group died (p = 0.229).

Reperfusion with and without blood venting has the sameoutcome regarding intra-operation hemodynamic and biochemical changes, PRSrate, and post-operation complication, as well as 6-month survival. So it seems thatblood venting could be omitted as a method for decreasing post reperfusion complications following LT.