Retrograde Reperfusion Versus Antegrade Liver Transplant Reperfusion

A Propensity Score Matched Pair Analysis of Retrograde Reperfusion Versus Antegrade Liver Transplant Reperfusion

A retrospective cohort analysis was performed comparing patients that had intra operative antegrade liver reperfusions versus patients that had retrograde liver perfusion.

Study Overview

• Status: Withdrawn
• Conditions: Liver Transplant Failure
• Intervention / Treatment: Procedure: Graft reperfusion

Detailed Description

A retrospective cohort analysis was performed comparing patients that had intra operative antegrade liver reperfusions versus patients that had retrograde liver perfusion. Antegrade Reperfusion(ATR) group: after completing the caval replacement or piggy-back, for IVC anastomosis, Portal vein (PV) anastomosis was done with a running suture as normal fashion, then it was followed by the removal the clamps, starting by the supra hepatic VC, followed by the PV clamp and finally the infrahepatic VC. It was followed by arterial anastomosis and the biliary anastomosis (duct-to-duct if possible). Retrograde group (RETR): after completing the piggyback the IVC was declamped immediately and retrograde low pressure reperfusion of the graft with low oxygenated venous blood was established. Central venous pressure was intended to be higher than in 8 mmHg to enable appropriate retrograde reperfusion in the transplanted liver. Significant venous backflow via portal vein appears immediately after declamping. Venous bleeding from the liver except portal backflow was stopped immediately after declamping the venous anastomosis, as appropriate. Portal vein anastomosis was performed using running suture. It was followed by arterial anastomosis and the biliary anastomosis (duct-to-duct if possible). The endpoints are patient survival and graft survival at 1, 3,5, 10 years post liver transplantation in both groups. To adjust for a selection bias, we will perform a propensity score analysis.

• Study Type: Observational

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients who have undergone transplantation of the liver at LHSC.

Description

Inclusion Criteria:

• all liver transplantations between 1 Jan 2002 and 31 Dec 2005

Exclusion Criteria:

• liver retransplantation
• multiorgan transplantation
• ABO incompatible transplantation

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Retrograde reperfusion; After completion of the inferior vena cava anastomosis, the clamps were removed to allow retrograde reperfusion of the graft.	Procedure: Graft reperfusion; antegrade (forward) or retrograde (backward) blood reperfusion of the liver graft
Antegrade reperfusion; After completion of the inferior vena cava anastomosis, the portal vein anastomosis is completed and then the clamps were removed to allow antegrade reperfusion of the graft.	Procedure: Graft reperfusion; antegrade (forward) or retrograde (backward) blood reperfusion of the liver graft

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Graft survival	Average length of time the liver graft remains in a living recipient regardless of function	From date of transplantation until the date of next transplantation or date of death from any cause, whichever came first, assessed up to 300 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient survival	Average length of time a recipient is alive regardless of presence of the second liver	From date of transplantation until the date of death from any cause assessed up to 300 months

Collaborators and Investigators

• Sponsor: London Health Sciences Centre

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2002
• Primary Completion (Actual): December 31, 2005
• Study Completion (Anticipated): February 28, 2020

Study Registration Dates

• First Submitted: February 16, 2019
• First Submitted That Met QC Criteria: February 16, 2019
• First Posted (Actual): February 19, 2019

Study Record Updates

• Last Update Posted (Actual): April 6, 2022
• Last Update Submitted That Met QC Criteria: April 4, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Other Study ID Numbers: 106793

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Study mechanisms and de-identified subject level data will be shared with researchers who contact the principal investigator.
• IPD Sharing Time Frame: From the time of publication for 5 years
• IPD Sharing Access Criteria: By contacting the PI and with permission of the REB
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No