Protection of the Intrahepatic Biliary Tree by Contemporaneous Portal and Arterial Reperfusion: Results of A Prospective Randomized Pilot Study.
Baccarani U, Rossetto A, et al.Updates in Surgery, 64(3): 173-177, 2012.
Aims
To explore whether contemporaneous portal vein and hepatic artery revascularization would confer beneficial effects on the recovery of graft function, reperfusion syndrome, vascular complications, 1-year patient and graft survival and biliary complications in liver transplant recipients.
Interventions
Graft being revascularized through portal vein and the hepatic artery sequentially versus graft being revascularized through portal vein and the hepatic artery simultaneously.
Participants
80 liver transplant recipients from heart beating donors.
Outcomes
Outcome measurement included warm ischemia time, cold ischemia time, arterial ischemic time; incidence of reperfusion syndrome, primary non-function, delayed graft function; 1-year patient and graft survival; biliary complications including anastomotic stenosis, biliary leakage and intrahepatic non-anastomotic biliary strictures. Other laboratory measurement included the level of aspartate aminotransferase, alanine aminotransferase, total bilirubin, coagulation, c-glutamyl transpeptidase and alkaline phosphatise.
Follow-up
12 months
CET Conclusions
The Udinese group have expanded upon work published last year to include 80 consecutive liver transplants from heart-beating donors. Contemporaneous portal and arterial revascularisation was associated with reduced intrahepatic biliary stenosis compared to sequential revascularisation. This is believed to be due to the slow re-warming of the liver via the portal vein whilst the arterial anastomosis is completed. There were no differences in the other outcomes reported.
Data analysis
Per protocol analysis
Trial registration
Not reported