title: Does arterialisation time influence biliary tract complications after orthotopic liver transplantation?
abstract: BACKGROUND
  In the cardiac death donor era, many reports deal with biliary tract complications and concerns about ischemic reperfusion injury owing to the exclusive arterial vascularization of the biliary tree, the warm ischemia time has been implicated as responsible for biliary lesions during organ procurement. We defined the arterialization time as the second warm ischemia time. Our purpose was to study the correlation between the arterialization time during liver implantation and the appearance of biliary lesions.
  
  
  METHODS
  We retrospectively collected data from the last 5-years of orthotopic liver transplantation: namely, indications, cold perfusion fluid, cold ischemia time, operative procedure times, and acute rejection events. We excluded split-liver transplantations, retransplantations, pediatric patients, transplantations for cholestatic disease, cases where hepatic artery thrombosis happened before biliary complications, or patients with posttransplant cytomegalovirus infection. We defined 2 groups: A) without biliary complications; and B) with biliary complications. We compared the mean arterialization time using Student t test to define whether the warm ischemic time during implantation was responsible for biliary tract complications. A P value of <.05 was considered to be significant.
  
  
  RESULTS
  Between 2004 and the end of 2008, we grafted 402 patients among whom 243 met the inclusion criteria: 198 in group A and 45 in group B. Only the cold ischemia time was significantly different between the 2 groups (P = .039).
  
  
  CONCLUSIONS
  After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage.
authors.affiliation: Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, 1 avenue Molière, 67098 Strasbourg Cedex, France. murat.cag@chru-strasbourg.fr
authors.forename: M
authors.initials: M
authors.lastname: Cag
authors.forename: M
authors.initials: M
authors.lastname: Audet
authors.forename: A C
authors.initials: AC
authors.lastname: Saouli
authors.forename: F
authors.initials: F
authors.lastname: Panaro
authors.forename: T
authors.initials: T
authors.lastname: Piardi
authors.forename: J
authors.initials: J
authors.lastname: Cinqualbre
authors.forename: P
authors.initials: P
authors.lastname: Wolf
mesh_terms: D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000401:mortality; D050377:Cold Ischemia / Q000009:adverse effects; D005602:France; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D052096:Warm Ischemia / Q000009:adverse effects*