Temporary Intraoperative Porto-Caval Shunts in Piggy-Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta-Analysis.
Pratschke S, Rauch A, et al.World Journal of Surgery 2016; 40(12): 2988-2998.
Aims
To conduct a meta-analysis to analyse the effect of temporary intraoperative porto-caval shunts (TPCS) on liver transplant outcomes.
Interventions
The databases MEDLINE, PubMed, EMBASE and PsycINFO were searched up until October 2014 for relevant studies including those published in English or German. All articles were independently screened for inclusion by two researchers.
Participants
6 articles were included in this meta-analysis.
Outcomes
The primary outcomes measured included hepatic injury, characteristics of the surgical intervention, renal function and health care utilization.
Follow-up
Not described
CET Conclusions
This is an interesting meta-analysis in which the authors are attempting to evaluate the value of a temporary intraoperative porto-caval shunt in cava-sparing liver transplantation, as this is a controversial topic. They attempted to evaluate the impact of a shunt on liver injury as judged by primary non-function, liver function, length of surgery, length of stay in hospital and the need for blood transfusion. Their systematic search only found six articles out of 909 that were relevant to their proposed study and the quality of most of these retrospective studies was not particularly good (there was only one randomised control trial). Despite these limitations their analysis does suggest that using a temporary porto-caval shunt was associated with lower AST values, fewer transfusions and better renal function postoperatively. However, the authors suggest that although the data is suggestive, it is not convincing and that randomised control trials to investigate the use of temporary intraoperative porto-caval shunts are needed to confirm the data arising from their meta-analysis.
Quality notes
Quality assessment not appropriate
Trial registration
None