Protection of the Intrahepatic Biliary Tree by Contemporaneous Portal and Arterial Reperfusion: Results of a Prospective Randomized Pilot Study

Overview

Journal Updates Surg

Specialty General Surgery

Date 2012 Jul 10

PMID 22773391

Citations 2

Authors

Umberto Baccarani

Anna Rossetto

Dario Lorenzin

Stefania Bidinost

Maria Laura Pertoldeo

Manuela Lugano

Vittorio Bresadola

Giorgio Della Rocca

Andrea Risaliti

Gian Luigi Adani

Affiliations

Soon will be listed here.

Abstract

Sequential portal and arterial revascularization (SPAr) is the most common method of graft reperfusion at liver transplantation (LT), contemporaneous portal and arterial revascularization (CPAr) was used to reduce arterial ischemia to the bile ducts. Aim of this pilot study is to prospectively compare SPAr (group 1 #38) versus CPAr (group 2 #42) in 80 consecutive LTs. Biliary anastomosis was always duct to duct [T-tube in 21 % of cases (p = 0.83) in both groups]. CPAr had longer warm ischemia 61 ± 10 versus 39 ± 13 min, p < 0.0001, while SPAr had longer arterial ischemia 96 ± 39 min (p = 0.0001). No PNF while DGF was encountered in 10 versus 5 % (p = 0.32). One-year graft and patient's survival were respectively 87 versus 93 % and 83 versus 88 % in groups 1 and 2 (p = 0.31 and p = 0.39). At a median follow-up of 19 ± 8 versus 17 ± 8 months (p = 0.24), biliary complications were 28 %, being 39 % in group 1 and 19 % in group 2 (p = 0.04). Anastomotic stenoses were present in 11 versus 12 % (p = 0.84), biliary leakage in 5 versus 5 % (p = 0.72) and intrahepatic non-anastomotic biliary strictures in 23 versus 0 % (p = 0.0008) in groups 1 and 2. CPAr is safe and feasible and reduces the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia to the intrahepatic bile ducts.

Citing Articles

Short- and Long-Term Outcomes of Different Reperfusion Sequences in Liver Transplantation.

Eichelmann A, Vogel T, Fuchs A, Houben P, Katou S, Becker F Ann Transplant. 2021; 26:e926847.

PMID: 33602890 PMC: 7901155. DOI: 10.12659/AOT.926847.

Identifying the Superior Reperfusion Technique in Liver Transplantation: A Network Meta-Analysis.

Yao Y, Wu P, Guo T Gastroenterol Res Pract. 2019; 2019:9034263.

PMID: 31641349 PMC: 6766671. DOI: 10.1155/2019/9034263.

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