Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation--a randomized clinical trial.
Initial nonfunction (INF) and biliary complications such as ischemic-type biliary lesion (ITBL) remain two major complications in clinical orthotopic liver transplantation (OLT). The influence of ischemia and reperfusion injury (I/R) as a significant risk factor for both complications is widely unquestioned. A new reperfusion technique that reduces I/R injury should lead to a reduction in both INF and ITBL. One hundred and thirty two OLT patients were included in this study and randomized into two groups. Group A underwent standard reperfusion with anterograde simultaneous arterial and portal reperfusion and group B received retrograde reperfusion via the vena cava before sequential anterograde reperfusion of portal vein and hepatic artery. Serum transaminase level as a surrogate parameter for I/R injury and serum bilirubin level as a parameter for graft function were significantly reduced during the first week after OLT in group B. INF rate was 7.7% in group A and 0% in group B (P = 0.058). ITBL incidence was 4.55% in group A versus 12.3% in group B (P = 0.053). Retrograde reperfusion seemed to be beneficial for hepatocytes, but was detrimental for the biliary epithelium. The unexplained increased incidence of ITBL after retrograde reperfusion will be focus of further investigation.
Heidenhain
Christoph
C
Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Universitätsmedizin Berlin, Berlin, Germany. christoph.heidenhain@charite.de
Heise
Michael
M
Jonas
Sven
S
Ben-Asseur
Manuela
M
Puhl
Gero
G
Mittler
Jens
J
Thelen
Armin
A
Schmidt
Sven
S
Langrehr
Jan
J
Neuhaus
Peter
P
D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000098:blood supply / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015424:Reperfusion / Q000379:methods*; D015427:Reperfusion Injury / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D014019:Tissue Donors; D014682:Vena Cava, Inferior