Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 7036-7046
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.7036
Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis
Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li
Jia-Zhong Wang, Yang Liu, Jin-Long Wang, Le Lu, Ya-Fei Zhang, Hong-Wei Lu, Yi-Ming Li, Department of General Surgery, Second Affiliated Hospital, Xi’an Jiaotong University School of Medicine, Xi’an 710004, Shaanxi Province, China
Author contributions: Li YM and Wang JZ conceived this meta-analysis, wrote the initial manuscript, critically reviewed and revised the manuscript; Wang JZ, Wang JL and Lu L acquired data, performed the initial data analysis; Lu HW critically supervised data acquisition and analysis; and Li YM approved the final version of the manuscript; all authors contributed to this paper.
Supported by National Natural Science Foundation of China, No. 81170454.
Conflict-of-interest: The authors declared that they have no conflicts of interest to this work.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Ming Li, Professor, Department of General Surgery, Second Affiliated Hospital, Xi’an Jiaotong University School of Medicine, 76 Yanta West Road, Xi’an 710004, Shaanxi Province, China. wjz05202156@stu.xjtu.edu.cn
Telephone: +86-29-87679746 Fax: +86-29-87679746
Received: November 26, 2014
Peer-review started: November 27, 2014
First decision: December 26, 2014
Revised: January 8, 2015
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: June 14, 2015
Processing time: 203 Days and 20.5 Hours
Abstract

AIM: We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation.

METHODS: A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ2 and I2 tests. The risk of publication bias was assessed using a funnel plot and Egger’s test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches.

RESULTS: Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001), and intensive care unit (ICU) days were decreased (MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis.

CONCLUSION: The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.

Keywords: Revascularization; Liver transplantation; Outcomes; Biliary complications; Meta-analysis

Core tip: The current methods of revascularization in liver transplantation can be divided into two main groups. We carried out this meta-analysis in order to study the relationship between revascularization and outcomes after liver transplantation. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (P < 0.00001), and intensive care unit days were decreased (P = 0.007) in the simultaneous revascularization group. There were no significant differences in other outcomes between sequential and simultaneous revascularization groups, such as blood transfusions, hospital days, graft failure and mortality in one month and one year, operation time.