Sequential or Simultaneous Portal-Arterial Reperfusion During Liver Transplantation: A Retrospective Study

BACKGROUND: Ischemia-reperfusion injury is a relevant complication in liver transplantation. Sequential (SeqR) and simultaneous reperfusion (SimR) techniques are the most commonly used strategies to reduce this injury; however, there is still no consensus regarding which technique provides better outcomes. This study compares these techniques in terms of graft recovery, complications, and patient survival. MATERIALS AND METHODS: This retrospective study included 872 patients who underwent liver transplantation, divided into 2 groups according to the reperfusion technique used. Patient characteristics, intraoperative and postoperative outcomes, as well as recipient and graft mortality and survival, were analyzed. Continuous variables were analyzed using Student's t-test, and categorical variables using Pearson's chi-square test, with a significance level of 5%. RESULTS: A total of 520 transplants were performed using SimR and 352 using SeqR. SimR was associated with shorter operative time (P < .001) and longer total ischemia time (P < .001). It was also associated with a higher incidence of biliary stricture (P = .032) and a lower rate of graft rejection (95% CI: 0.342-0.754; OR: 0.508; P < .001). Overall recipient survival was significantly higher in the SimR group (P = .002). DISCUSSION AND CONCLUSIONS: In this study, the SimR technique was significantly associated with improved overall recipient survival, despite being associated with longer total ischemia time. SimR was also correlated with a higher incidence of biliary strictures but demonstrated a protective effect against graft rejection. These findings should be confirmed in prospective, randomized studies.