{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T07:36:37Z","timestamp":1765438597806},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T00:00:00Z","timestamp":1569456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T00:00:00Z","timestamp":1569456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>The use of a temporary portocaval shunt (TPCS) as well as the order of reperfusion (initial arterial reperfusion [IAR] versus initial portal reperfusion) in orthotopic liver transplantation (OLT) is controversial and, therefore, still under debate. The aim of this study was to evaluate outcome for the 4 possible combinations (temporary portocaval shunt with initial arterial reperfusion [A+S+], temporary portocaval shunt with initial portal reperfusion, no temporary portocaval shunt with initial arterial reperfusion, and no temporary portocaval shunt with initial portal reperfusion) in a center\u2010based cohort study, including liver transplantations (LTs) from both donation after brain death and donation after circulatory death (DCD) donors. The primary outcome was the perioperative transfusion of red blood cells (RBCs), and the secondary outcomes were operative time and patient and graft survival. Between January 2005 and May 2017, all first OLTs performed in our institution were included in the 4 groups mentioned. With IAR and TPCS, a significantly lower perioperative transfusion of RBCs was seen (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) as well as a higher number of recipients without any transfusion of RBCs (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). A multivariate analysis showed laboratory Model for End\u2010Stage Liver Disease (MELD) score (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and IAR (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.01) to be independent determinants of the transfusion of RBCs. When comparing all groups, no statistical difference was seen in operative time or in 1\u2010year patient and graft survival rates despite more LTs with a liver from a DCD donor in the A+S+ group (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.005). In conclusion, next to a lower laboratory MELD score, the use of IAR leads to a significantly lower need for perioperative blood transfusion. There was no significant interaction between IAR and TPCS. Furthermore, the use of a TPCS and\/or IAR does not lead to increased operative time and is therefore a reasonable alternative surgical strategy.<\/jats:p>","DOI":"10.1002\/lt.25592","type":"journal-article","created":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T13:44:38Z","timestamp":1562334278000},"page":"1690-1699","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation"],"prefix":"10.1097","volume":"25","author":[{"given":"Lars Cornelis","family":"Pietersen","sequence":"first","affiliation":[{"name":"Division of Transplantation, Departments of Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elise","family":"Sarton","sequence":"additional","affiliation":[{"name":"Anesthesiology,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Alwayn","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Departments of Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hwai\u2010Ding","family":"Lam","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Departments of Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hein","family":"Putter","sequence":"additional","affiliation":[{"name":"Medical Statistics,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart","family":"van Hoek","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology,Leiden University Medical Center,Leiden,the 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