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ORIGINAL RESEARCH article

Front. Surg.
Sec. Visceral Surgery
Volume 11 - 2024 | doi: 10.3389/fsurg.2024.1356142

A novel proceduralized donor liver back-table preparation technique minimizes hemorrhage following liver implantation in orthotropic liver transplantation

Provisionally accepted
Rui Tang Rui Tang Guangdong Wu Guangdong Wu Xuan Tong Xuan Tong Lihan Yu Lihan Yu Ang Li Ang Li Jingyi Lin Jingyi Lin Guangxun Xu Guangxun Xu Qian Lu Qian Lu *
  • Hepatopancreatobiliary Center, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Beijing, Beijing Municipality, China

The final, formatted version of the article will be published soon.

    Background: Intraoperative hemorrhage is one of the major complications of orthotopic liver transplantation (OLTX) and is mainly caused by technical difficulties of the surgical procedure beside the primary liver diseases. The aims of the present study were to evaluate the feasibility and clinical effects of a novel proceduralized donor liver back-table preparation (DLBTP) technique for use in OLTX. Methods: This retrospective study was conducted between January 2018 and June 2020 based on patients who had undergone OLTX. All livers transplanted using the reported back-table procedures were defined as the control group A (n = 43), while those prepared using our new procedure as the experimental group B (n = 160). The first-hand surgical experience of transplant surgeons was surveyed in a post hoc comparative analysis. Results: DLBTP time was significantly longer and the probability of low-quality hepatic artery skeletonization was lower in group B compared to group A patients. Compared to group A, the time for hemorrhage control was shorter (P < 0.05, 0.3 h [range: 0.17-0.58 h]) and the degree of blood loss was less (P < 0.05, 60 mL [range: 30-240 mL]) in group B. Major bleeding sites were soft tissue of the hepatic hilum and the wall of the inferior vena cava. Due to trimmed soft tissue in the first porta hepatis region, there was less blood oozing, making it easier to stem the bleeding and construct an anastomosis. Conclusion: Although the procedural DLBTP for OLTX was time-consuming, the new procedure significantly reduced the degree of hemorrhage and the time required to control bleeding.

    Keywords: Back-table procedure, Hepatic artery variation, Orthotropic liver transplantation, Procedural donor liver preparation, Extracorporeal donor liver preparation

    Received: 15 Dec 2023; Accepted: 18 Nov 2024.

    Copyright: © 2024 Tang, Wu, Tong, Yu, Li, Lin, Xu and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Qian Lu, Hepatopancreatobiliary Center, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Beijing, Beijing Municipality, China

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