The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation: A meta-analysis
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摘要
Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion(sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion(sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion(sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
引文
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[5]LladóL,Figueras J.Techniques of orthotopic liver transplantation.HPB(Oxford)2004;6:69-75.
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[7]Panaro F,Chauvat J,Carabalona JP,Nougaret S,Bouyabrine H,Marchand JP,et al.Double arterial anastomosis in liver transplantation:is two better than one?J Gastrointest Surg 2013;17:1512-1515.
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[9]Hwang S.Microcirculation of the liver.In:Madoff DC,Makuuchi M ITVJ-N,editors.Venous Embolization Liver Radiol.Surg.Pract.London:Springer;2011:9-13.
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[11]Tawadrous MN,Zimmermann A,Zhang XY,Wheatley AM.Persistence of impaired hepatic microcirculation after nonarterialized liver transplantation in the rat.Microcirculation 2002;9:363-375.
[12]Adani GL,Rossetto A,Bresadola V,Lorenzin D,Baccarani U,De Anna D.Contemporaneous portal-arterial reperfusion during liver transplantation:preliminary results.J Transplant 2011;2011:251656.
[13]Polak WG,Miyamoto S,Nemes BA,Peeters PM,de Jong KP,Porte RJ,et al.Sequential and simultaneous revascularization in adult orthotopic piggyback liver transplantation.Liver Transpl 2005;11:934-940.
[14]Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240:205-213.
[15]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions,Higgins JPT,Green S,editors.Vol.5.London:Cochrane Collaboration and John Wiley&Sons Ltd;2008.
[16]Kjaergard LL,Villumsen J,Gluud C.Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses.Ann Intern Med 2001;135:982-989.
[17]Moher D,Pham B,Jones A,Cook DJ,Jadad AR,Moher M,et al.Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?Lancet 1998;352:609-613.
[18]Schulz KF,Chalmers I,Hayes RJ,Altman DG.Empirical evidence of bias.Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.JAMA 1995;273:408-412.
[19]Wood L,Egger M,Gluud LL,Schulz KF,Jüni P,Altman DG,et al.Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes:meta-epidemiological study.BMJ2008;336:601-605.
[20]West S,King V,Carey TS,Lohr KN,Mc Koy N,Sutton SF,et al.Systems to rate the strength of scientific evidence.Evid Rep Technol Assess(Summ)2002;47:1-11.
[21]Hozo SP,Djulbegovic B,Hozo I.Estimating the mean and variance from the median,range,and the size of a sample.BMC Med Res Methodol 2005;5:13.
[22]DerSimonian R,Laird N.Meta-analysis in clinical trials.Control Clin Trials1986;7:177-188.
[23]Borenstein M,Higgins JP,Hedges LV,Rothstein HR.Basics of meta-analysis:I2 is not an absolute measure of heterogeneity.Res Synth Methods 2017;8:5-18.
[24]Higgins JP,Thompson SG.Quantifying heterogeneity in a meta-analysis.Stat Med 2002;21:1539-1558.
[25]Higgins JP.Commentary:heterogeneity in meta-analysis should be expected and appropriately quantified.Int J Epidemiol 2008;37:1158-1160.
[26]Newell DJ.Intention-to-treat analysis:implications for quantitative and qualitative research.Int J Epidemiol 1992;21:837-841.
[27]Sweeting MJ,Sutton AJ,Lambert PC.What to add to nothing?Use and avoidance of continuity corrections in meta-analysis of sparse data.Stat Med2004;23:1351-1375.
[28]Macaskill P,Walter SD,Irwig L.A comparison of methods to detect publication bias in meta-analysis.Stat Med 2001;20:641-654.
[29]Sterne JA,Egger M.Funnel plots for detecting bias in meta-analysis:guidelines on choice of axis.J Clin Epidemiol 2001;54:1046-1055.
[30]Egger M,Davey Smith G,Schneider M,Minder C.Bias in meta-analysis detected by a simple,graphical test.BMJ 1997;315:629-634.
[31]Ducerf C,Mechet I,Landry JL,DeLaRoche E,Berthoux N,Bourdeix O,et al.Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization.J Am Coll Surg 20 0 0;190:89-93.
[32]Moreno C,SabatéA,Figueras J,CamprubíI,Dalmau A,Fabregat J,et al.Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation:influence of hepatic artery or portal vein revascularization of the graft.Liver Transpl 2006;12:1607-1614.
[33]Sankary HN,Mc Chesney L,Frye E,Cohn S,Foster P,Williams J.A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation.Hepatology1995;21:63-69.
[34]Massarollo PC,Mies S,Raia S.Simultaneous arterial and portal revascularization in liver transplantation.Transplant Proc 1998;30:2883-2884.
[35]Lu D,Xu X,Wang J,Ling Q,Xie H,Zhou L,et al.The influence of a contemporaneous portal and hepatic artery revascularization protocol on biliary complications after liver transplantation.Surgery 2014;155:190-195.
[36]Baccarani U,Rossetto A,Lorenzin D,Bidinost S,Pertoldeo ML,Lugano M,et al.Protection of the intrahepatic biliary tree by contemporaneous portal and arterial reperfusion:results of a prospective randomized pilot study.Updates Surg 2012;64:173-177.
[37]Polak WG,Porte RJ.The sequence of revascularization in liver transplantation:it does make a difference.Liver Transpl 2006;12:1566-1570.
[38]Zhu XH,Pan JP,Wu YF,Ding YT.Effects of warm ischemia time on biliary injury in rat liver transplantation.World J Gastroenterol 2012;18:6308-6314.
[39]Zhu XH,Pan JP,Wu YF,Ding YT.Establishment of a rat liver transplantation model with prolonged biliary warm ischemia time.World J Gastroenterol2012;18:7194-7200.
[40]Levesque E,Duclos J,Ciacio O,Adam R,Castaing D,Vibert E.Influence of larger graft weight to recipient weight on the post-liver transplantation course.Clin Transplant 2013;27:239-247.
[41]Wang JZ,Liu Y,Wang JL,Lu L,Zhang YF,Lu HW,et al.Sequential vs simultaneous revascularization in patients undergoing liver transplantation:a metaanalysis.World J Gastroenterol 2015;21:7036-7046.
[42]Adani GL,Rossetto A,Lorenzin D,Lugano M,De Anna D,Della Rocca G,et al.Sequential versus contemporaneous portal and arterial reperfusion during liver transplantation.Transplant Proc 2011;43:1107-1109.
[43]Wu DG,Zheng SG,Dong JH,Wang SG,Bie P.Comparative study of two intraoperative reperfusion modes affecting liver function at the early stage after orthotopic liver transplantation.J Dig Surg 2006;3:175-178.
[2]?berg F,Gissler M,Karlsen TH,Ericzon BG,Foss A,Rasmussen A,et al.Differences in long-term survival among liver transplant recipients and the general population:a population-based Nordic study.Hepatology 2015;61:668-677.
[3]Jain A,Reyes J,Kashyap R,Dodson SF,Demetris AJ,Ruppert K,et al.Long-term survival after liver transplantation in 4,0 0 0 consecutive patients at a single center.Ann Surg 20 0 0;232:490-50 0.
[4]Wojcicki M,Milkiewicz P,Silva M.Biliary tract complications after liver transplantation:a review.Dig Surg 2008;25:245-257.
[5]LladóL,Figueras J.Techniques of orthotopic liver transplantation.HPB(Oxford)2004;6:69-75.
[6]Hosein Shokouh-Amiri M,Osama Gaber A,Bagous WA,Grewal HP,Hathaway DK,Vera SR,et al.Choice of surgical technique influences perioperative outcomes in liver transplantation.Ann Surg 20 0 0;231:814-823.
[7]Panaro F,Chauvat J,Carabalona JP,Nougaret S,Bouyabrine H,Marchand JP,et al.Double arterial anastomosis in liver transplantation:is two better than one?J Gastrointest Surg 2013;17:1512-1515.
[8]Manzini G,Kremer M,Houben P,Gondan M,Bechstein WO,Becker T,et al.Reperfusion of liver graft during transplantation:techniques used in transplant centres within Eurotransplant and meta-analysis of the literature.Transpl Int 2013;26:508-516.
[9]Hwang S.Microcirculation of the liver.In:Madoff DC,Makuuchi M ITVJ-N,editors.Venous Embolization Liver Radiol.Surg.Pract.London:Springer;2011:9-13.
[10]Wang MF,Jin ZK,Chen DZ,Li XL,Zhao X,Fan H.Risk factors of severe ischemic biliary complications after liver transplantation.Hepatobiliary Pancreat Dis Int2011;10:374-379.
[11]Tawadrous MN,Zimmermann A,Zhang XY,Wheatley AM.Persistence of impaired hepatic microcirculation after nonarterialized liver transplantation in the rat.Microcirculation 2002;9:363-375.
[12]Adani GL,Rossetto A,Bresadola V,Lorenzin D,Baccarani U,De Anna D.Contemporaneous portal-arterial reperfusion during liver transplantation:preliminary results.J Transplant 2011;2011:251656.
[13]Polak WG,Miyamoto S,Nemes BA,Peeters PM,de Jong KP,Porte RJ,et al.Sequential and simultaneous revascularization in adult orthotopic piggyback liver transplantation.Liver Transpl 2005;11:934-940.
[14]Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240:205-213.
[15]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions,Higgins JPT,Green S,editors.Vol.5.London:Cochrane Collaboration and John Wiley&Sons Ltd;2008.
[16]Kjaergard LL,Villumsen J,Gluud C.Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses.Ann Intern Med 2001;135:982-989.
[17]Moher D,Pham B,Jones A,Cook DJ,Jadad AR,Moher M,et al.Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?Lancet 1998;352:609-613.
[18]Schulz KF,Chalmers I,Hayes RJ,Altman DG.Empirical evidence of bias.Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.JAMA 1995;273:408-412.
[19]Wood L,Egger M,Gluud LL,Schulz KF,Jüni P,Altman DG,et al.Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes:meta-epidemiological study.BMJ2008;336:601-605.
[20]West S,King V,Carey TS,Lohr KN,Mc Koy N,Sutton SF,et al.Systems to rate the strength of scientific evidence.Evid Rep Technol Assess(Summ)2002;47:1-11.
[21]Hozo SP,Djulbegovic B,Hozo I.Estimating the mean and variance from the median,range,and the size of a sample.BMC Med Res Methodol 2005;5:13.
[22]DerSimonian R,Laird N.Meta-analysis in clinical trials.Control Clin Trials1986;7:177-188.
[23]Borenstein M,Higgins JP,Hedges LV,Rothstein HR.Basics of meta-analysis:I2 is not an absolute measure of heterogeneity.Res Synth Methods 2017;8:5-18.
[24]Higgins JP,Thompson SG.Quantifying heterogeneity in a meta-analysis.Stat Med 2002;21:1539-1558.
[25]Higgins JP.Commentary:heterogeneity in meta-analysis should be expected and appropriately quantified.Int J Epidemiol 2008;37:1158-1160.
[26]Newell DJ.Intention-to-treat analysis:implications for quantitative and qualitative research.Int J Epidemiol 1992;21:837-841.
[27]Sweeting MJ,Sutton AJ,Lambert PC.What to add to nothing?Use and avoidance of continuity corrections in meta-analysis of sparse data.Stat Med2004;23:1351-1375.
[28]Macaskill P,Walter SD,Irwig L.A comparison of methods to detect publication bias in meta-analysis.Stat Med 2001;20:641-654.
[29]Sterne JA,Egger M.Funnel plots for detecting bias in meta-analysis:guidelines on choice of axis.J Clin Epidemiol 2001;54:1046-1055.
[30]Egger M,Davey Smith G,Schneider M,Minder C.Bias in meta-analysis detected by a simple,graphical test.BMJ 1997;315:629-634.
[31]Ducerf C,Mechet I,Landry JL,DeLaRoche E,Berthoux N,Bourdeix O,et al.Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization.J Am Coll Surg 20 0 0;190:89-93.
[32]Moreno C,SabatéA,Figueras J,CamprubíI,Dalmau A,Fabregat J,et al.Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation:influence of hepatic artery or portal vein revascularization of the graft.Liver Transpl 2006;12:1607-1614.
[33]Sankary HN,Mc Chesney L,Frye E,Cohn S,Foster P,Williams J.A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation.Hepatology1995;21:63-69.
[34]Massarollo PC,Mies S,Raia S.Simultaneous arterial and portal revascularization in liver transplantation.Transplant Proc 1998;30:2883-2884.
[35]Lu D,Xu X,Wang J,Ling Q,Xie H,Zhou L,et al.The influence of a contemporaneous portal and hepatic artery revascularization protocol on biliary complications after liver transplantation.Surgery 2014;155:190-195.
[36]Baccarani U,Rossetto A,Lorenzin D,Bidinost S,Pertoldeo ML,Lugano M,et al.Protection of the intrahepatic biliary tree by contemporaneous portal and arterial reperfusion:results of a prospective randomized pilot study.Updates Surg 2012;64:173-177.
[37]Polak WG,Porte RJ.The sequence of revascularization in liver transplantation:it does make a difference.Liver Transpl 2006;12:1566-1570.
[38]Zhu XH,Pan JP,Wu YF,Ding YT.Effects of warm ischemia time on biliary injury in rat liver transplantation.World J Gastroenterol 2012;18:6308-6314.
[39]Zhu XH,Pan JP,Wu YF,Ding YT.Establishment of a rat liver transplantation model with prolonged biliary warm ischemia time.World J Gastroenterol2012;18:7194-7200.
[40]Levesque E,Duclos J,Ciacio O,Adam R,Castaing D,Vibert E.Influence of larger graft weight to recipient weight on the post-liver transplantation course.Clin Transplant 2013;27:239-247.
[41]Wang JZ,Liu Y,Wang JL,Lu L,Zhang YF,Lu HW,et al.Sequential vs simultaneous revascularization in patients undergoing liver transplantation:a metaanalysis.World J Gastroenterol 2015;21:7036-7046.
[42]Adani GL,Rossetto A,Lorenzin D,Lugano M,De Anna D,Della Rocca G,et al.Sequential versus contemporaneous portal and arterial reperfusion during liver transplantation.Transplant Proc 2011;43:1107-1109.
[43]Wu DG,Zheng SG,Dong JH,Wang SG,Bie P.Comparative study of two intraoperative reperfusion modes affecting liver function at the early stage after orthotopic liver transplantation.J Dig Surg 2006;3:175-178.