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Protection of the intrahepatic biliary tree by contemporaneous portal and arterial reperfusion: results of a prospective randomized pilot study.

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.
AuthorsUmberto Baccarani, Anna Rossetto, Dario Lorenzin, Stefania Bidinost, Maria Laura Pertoldeo, Manuela Lugano, Vittorio Bresadola, Giorgio Della Rocca, Andrea Risaliti, Gian Luigi Adani
JournalUpdates in surgery (Updates Surg) Vol. 64 Issue 3 Pg. 173-7 (Sep 2012) ISSN: 2038-131X [Print] Italy
PMID22773391 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
Topics
  • Adult
  • Anastomosis, Surgical (methods)
  • Bile Ducts, Intrahepatic (blood supply, surgery)
  • Cholestasis, Intrahepatic (complications, prevention & control)
  • Female
  • Follow-Up Studies
  • Graft Rejection (etiology, prevention & control)
  • Graft Survival
  • Hepatic Artery (surgery)
  • Humans
  • Ischemia (complications, prevention & control)
  • Liver Transplantation (adverse effects, methods)
  • Male
  • Middle Aged
  • Pilot Projects
  • Portal Vein (surgery)
  • Prospective Studies
  • Reperfusion (methods)
  • Time Factors
  • Treatment Outcome

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