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

Conventional ischemia-free liver transplantation (CIFLT) represents a pioneering procedure that circumvents ischemia-reperfusion injury 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 an 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 vs. 51.6±2.4 min, p =0.03), along with a comparatively reduced intraoperative blood loss compared to those who underwent CIFLT. Furthermore, the SIFLT group exhibited significantly lower peak AST levels within postoperative 7 days (413.1±62.6 vs. 707.5±110.7 U/L, p =0.02). The incidence of early allograft dysfunction, primary nonfunction, and transplant-related complications were similar across both groups. There were no significant differences in the number of Clavien-Dindo classification of surgical complications and comprehensive complication index at 3 months after transplantation. Kaplan-Meier analysis confirmed similar patient and graft survival rates. The subgroup analysis of extended criteria donor demonstrated that SIFLT can effectively reduce anhepatic phase and intraoperative blood loss and can achieve a clinical prognosis similar to CIFLT. Additionally, histological analysis revealed that both groups demonstrated well-preserved livers and bile ducts. The SIFLT simplifies the intricate surgical procedure while ensuring the protection of livers from ischemia-reperfusion injury. This technique holds promise for enabling patients to achieve clinical outcomes comparable to those of CIFLT.