Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature

Transpl Int. 2013 May;26(5):508-16. doi: 10.1111/tri.12083. Epub 2013 Mar 21.


It remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs.

Publication types

  • Meta-Analysis
  • Multicenter Study
  • Review
  • Systematic Review

MeSH terms

  • Europe / epidemiology
  • Hepatic Artery / physiology
  • Humans
  • Liver Circulation / physiology
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Liver Transplantation / mortality
  • Portal Vein / physiology
  • Randomized Controlled Trials as Topic
  • Reperfusion / adverse effects
  • Reperfusion / methods*
  • Surveys and Questionnaires
  • Treatment Outcome