Simplified ischemia-free liver transplantation by providing alternating flow of the portal vein and hepatic artery: Applicability, efficiency, safety

Conventional ischemia-free liver transplantation (CIFLT) represents a pioneering procedure that circumvents ischemia-reperfusion injury (IRI) to livers throughout the transplant procedure. However, its complexity has limited its widespread adoption. This study introduced a simplified ischemia-free liver transplantation (SIFLT) technique by providing alternating flow of the portal vein and hepatic artery, demonstrating its efficacy and safety. In this retrospective study, 32 patients who received SIFLT and 32 who received CIFLT were included between January 2021 and January 2024. The intraoperative and postoperative outcomes were collected and elevated. Patients who underwent SIFLT had a shorter anhepatic phase (44.0±2.4 mins vs 51.6±2.4 mins, p=0.03), along with a comparatively reduced intraoperative blood loss compared to those underwent CIFLT. Furthermore, the SIFLT group exhibited significantly lower peak AST levels within postoperative 7 days (413.1±62.6 U/L vs 707.5±110.7 U/L, p=0.02). The incidence of early allograft dysfunction, primary non-function, transplant-related complications were similar across both groups. There were no significant differences in number of Clavien-Dindo classification of surgical complication and comprehensive complication index at 3-month after transplantation. Kaplan-Meier analysis confirmed similar patient and graft survival rates. The subgroup analysis of extended criteria donors demonstrated that SIFLT can effectively reduce anhepatic phase and intraoperative blood loss, and can achieve clinical prognosis similar to CIFLT. Additionally, histological analysis revealed that both groups demonstrated well-preserved liver and bile duct. The SIFLT simplifies the intricate surgical procudure while ensuring protection of livers from IRI. This technique holds promise for enabling patients to achieve clinical outcomes comparable to those of CIFLT.