[Arterial back table pressure perfusion prevents ischemic biliary lesions after orthotopic liver transplantation].
BACKGROUND
Ischemic biliary lesions are a threatening complication following orthotopic liver transplantation. Their exact pathophysiological mechanism is unknown so far, but insufficient perfusion of biliary arterial vessels might be responsible for the development of these lesions. This might be changed by improved perfusion techniques. We performed a controlled study of cases since February 2000.


METHODS
We used arterial back table pressure perfusion to achieve reliable perfusion of the capillary system of the biliary tract, which may be impaired by the high viscosity of University of Wisconsin solution. In this study, 190 orthotopic liver transplantations performed between September 1997 and July 2002 were investigated with regard to ischemic biliary lesions.


RESULTS
One hundred thirty-one grafts were preserved by in situ standard perfusion including portal perfusion,whereas additional arterial back table pressure perfusion was performed in 59 cases. Donor-related factors, recipient age, indications for transplantation, transplantation techniques, and ischemia times were comparable between groups. Twenty-one (16%) of the patients in the standard perfusion group and only one of the those receiving arterial back table pressure perfusion developed ischemic biliary lesions. This difference was highly significant (P=0.004). Maximal aspartate aminotransferase and alanine aminotransferase levels in the first 3 days were significantly lower in the arterial back table pressure perfusion group (P>0.05).


CONCLUSIONS
Arterial back table pressure perfusion is an easy and reliable method for preventing ischemic biliary lesions in orthotopic liver transplantation. It should, therefore, be the standard technique in liver procurement.
Moench
C
C
Abteilung für Transplantationschirurgie, Chirurgie von Leber, Gallenwegen und Pankreas, Klinikum der Johannes-Gutenberg-Universität Mainz.
Moench
K
K
Lohse
A W
AW
Thies
J C
JC
Otto
G
G
D000241:Adenosine / Q000008:administration & dosage; D000328:Adult; D000493:Allopurinol / Q000008:administration & dosage; D000792:Angiography; D001659:Biliary Tract / Q000098:blood supply*; D002196:Capillaries / Q000000981:diagnostic imaging; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005978:Glutathione / Q000008:administration & dosage; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006874:Hydrostatic Pressure; D007328:Insulin / Q000008:administration & dosage; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000008:administration & dosage; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D011887:Raffinose / Q000008:administration & dosage; D015427:Reperfusion Injury / Q000000981:diagnostic imaging / Q000517:prevention & control*
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose