ABSTRACT Introduction: many revascularization techniques were designed to reduce the imbalance of ischemia-reperfusion injury. This study’s objective is to evaluate retrograde reperfusion (RR) compared to sequential anterograde reperfusion (AR), with and without the washout technique (WO). Method: this prospective cohort study collected data from 94 deceased donor orthotopic liver transplants and divided it into three groups: RR with WO (RR+WO), AP with WO (AR+WO), and AP without WO (AR). This study did not assign the reperfusion technique to the participants. The primary outcome considered the early graft dysfunction, and secondary outcomes included post-reperfusion syndrome (PRS), post-reperfusion lactate, surgery fluid balance, and vasoactive drug dose during the surgery. Results: 87 patients were submitted to the final analysis-29 in the RR+WO group, 27 in the AR+WO group, and 31 in the AR group. Marginal grafts prevalence was not significantly different between the groups (34% vs. 22% vs. 23%; p=0.49) and early graft dysfunction occurred at the same rate (24% vs. 26% vs. 19%; p=0.72). RR+WO reduced serum post-reperfusion lactate (p=0.034) and the incidence of significant PRS (17% vs. 33% vs. 55%; p=0.051), but norepinephrine dosing >0.5mcg/kg/min were not different during the surgery (20,7% vs. 29,6% vs. 35,5%, p=0.45). Conclusions: primary outcome was not significantly different between the groups; however, intraoperative hemodynamic management was safer using the RR+WO technique. We theorized that the RR+WO technique could reduce the incidence of PRS and benefit marginal graft survival following diseased donor orthotopic liver transplantation.

RESUMO Introdução: várias técnicas de reperfusão foram desenvolvidas a fim de reduzir o dano da lesão induzida por isquemia-reperfusão. Este estudo objetivou avaliar a reperfusão retrograda (RR) comparado com a reperfusão anterógrada (AR), com e sem a realização da técnica de lavagem do enxerto (WO). Métodos: coorte prospectiva com 94 transplantes ortotópicos de fígado de doador falecido divididos em três grupos: RR com WO (RR+WO), reperfusão anterógrada com WO (AR+WO), e AR sem WO (AR). Este estudo não designou a técnica de reperfusão entre os participantes. O desfecho primário considerou a disfunção precoce do enxerto, e os desfechos secundários incluíram a síndrome pós-reperfusão (SPR), lactato pós-reperfusão, balanço hídrico operatório, e uso de drogas vasoativas durante o ato peratório. Resultados: 87 pacientes foram submetidos para consolidação dos dados-29 no RR+WO, 27 no AR+WO, e 31 no AR. A prevalência de enxertos maginais não diferiu entre os grupos (34% vs 22% vs 23%; p=0,49). Disfunção precoce do enxerto ocorreu em uma proporção similar (24% vs 26% vs 19%; p=0,72). RR+WO reduziu o lactato sérico pós-reperfusão (p=0,034) e a incidência de SPR severa (17% vs 33% vs 55%; p=0,051), entretanto a infusão de noradrenalina >0,5mcg/kg/min não foi diferente durante a cirurgia (20,7% vs 29,6% vs 35,5%, p=0,45). Conclusões: o desfecho primário não diferiu significativamente entre os grupos; entretanto, o manejo hemodinâmico intra-operatório foi mais seguro no grupo RR+WO. Nós teorizamos que a técnica RR+WO pode reduzir a SPR e beneficiar enxertos marginais no transplante de fígado.

ABSTRACT Polycystic liver disease, a hereditary pathology, usually manifests as autosomal dominant polycystic kidney disease. The many cysts in the liver cause massive hepatomegaly, majorly affecting the patient’s quality of life. In cases of refractory symptoms, liver transplantation is the only treatment choice. A 43-year-old woman was followed up as a hepatology outpatient in August 2020, with a progressive increase in abdominal volume, lower limb edema, and cachexia. The patient was diagnosed with polycystic renal and liver disease with massive hepatomegaly in March 2021, a combined kidney-liver transplant. Liver size represented 13% of the patient’s corporal composition, weighing 8.6kg. The patient was discharged on the 7th postoperative day with no complications. Only 10-20% of patients with polycystic liver disease have clinical manifestations, most of which result from hepatomegaly. An increase in liver volume deteriorates liver function until the condition becomes end-stage liver disease, as kidney function is already compromised; liver-kidney transplantation remains the only treatment choice. The case described drew significant attention to the massive hepatomegaly presented in the patient, with the liver representing over 10% of the patient’s body weight, approximately five to six times larger than a normal-sized liver.