The influence of a contemporaneous portal and hepatic artery revascularization protocol on biliary complications after liver transplantation.
BACKGROUND
We sought to compare the impact of sequential and contemporaneous revascularizations of portal vein and hepatic artery on biliary complications in patients undergoing liver transplantation.


METHODS
We reviewed 184 patients who underwent liver transplantation in our center, and categorized them into different groups based on the duration of time between the portal venous and hepatic arterial reperfusion: >10 minutes in the sequential portal and hepatic artery revascularization group (SPA; n = 56), and within 1 minute in the contemporaneous portal and hepatic artery revascularization group (CPA; n = 121).The other patients with an interval from 1-10 minutes (n = 7) were excluded. This study then compared the outcomes between the SPA and CPA groups.


RESULTS
Cold ischemic time (mean ± standard deviation) for the SPA and CPA groups were 561 ± 150 vs 577 ± 187 minutes, respectively (P = .53). The incidence of biliary complications for the SPA and CPA groups were 14/56 and 11/121, respectively (25% vs 9%; P = .005). By the Clavien-Dindo Classification of Surgical Complications, the biliary complications in SPA group tended to be more severe compared with the CPA group (grade I, 0% vs 0%; II, 14% vs 36%; IIIa, 71% vs 64%; IIIb, 7% vs 0%; IV, 7% vs 0%; P = .10). Among biliary complications, the incidence of nonanatomic strictures was greater in the SPA group (9% vs 2%; P = .03), whereas the difference was not significant for anastomotic strictures (P = .054). Except for a lower serum albumin level in the SPA group 1 day after liver transplantation (P < .001), there are no differences in post-transplant liver function or renal function at 1, 7, and 30 days after transplantation.


CONCLUSIONS
The CPA protocol can decrease the incidence of biliary complications substantially after liver transplantation and should replace the SPA protocol used by some centers in liver transplantation.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Di
D
Lu
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Xiao
X
Xu
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Jianguo
J
Wang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Qi
Q
Ling
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Haiyang
H
Xie
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Lin
L
Zhou
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Sheng
S
Yan
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Weilin
W
Wang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Min
M
Zhang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Yan
Y
Shen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: zyzss@zju.edu.cn.
Shusen
S
Zheng
D000328:Adult; D001649:Bile Duct Diseases / Q000209:etiology*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007677:Kidney Function Tests; D008099:Liver / Q000098:blood supply*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult