Antegrade Hepatic Artery and Portal Vein Perfusion Versus Portal Vein Perfusion Alone in Living Donor Liver Transplantation: A Randomized Trial

Abstract

Traditionally, deceased donor liver grafts receive dual perfusion (DP) through the portal vein and the hepatic artery (HA) either in situ or on the back table. HA perfusion is avoided in living donor liver grafts for fear of damage to the intima and consequent risk of hepatic artery thrombosis (HAT). However, biliary vasculature is predominantly derived from the HA. We hypothesized that antegrade perfusion of the HA in addition to the portal vein on the back table could reduce the incidence of postoperative biliary complications. Consecutive adult patients undergoing living donor liver transplantations were randomized after donor hepatectomy to receive graft perfusion of histidine‐tryptophan‐ketoglutarate solution either via both the HA and portal vein (DP group, n = 62) or only through the portal vein (standard perfusion [SP] group, n = 62). The primary endpoint was the occurrence of biliary complications (biliary leak/stricture). Secondary endpoints included HAT and patient survival. The incidence of biliary stricture was significantly lower in the DP group (6.5% versus 19.4%; odds ratio, 0.29; 95% confidence interval, 0.09‐0.95; P = 0.04). There was no significant reduction in the incidence of HAT, bile leak, or hospital stay between the 2 groups. The 3‐year mortality and graft survival rates were significantly higher among patients who received DP compared with SP (P = 0.004 and P = 0.003, respectively). On multivariate analysis, nonperfusion of the HA and preceding bile leak were found to be risk factors for the development of biliary stricture (P = 0.04 and P < 0.001, respectively). In conclusion, DP of living donor liver grafts through both the HA and portal vein on the back table may protect against the development of biliary stricture. This could translate to improved patient survival in the short term.

Predicting Early Post-Transplant Mortality: The Role of ICU Stay in Liver Transplant Recipients with HBV-Related Cirrhosis

“…Only the duration of ICU stay was significantly higher in the patients with mortality [11 (7-21) versus (4-7), p<0.001]. The MELD-Na score among the patients who survived and patients with early mortality was 17 (14)(15)(16)(17)(18)(19)(20)(21)(22) and 20 (17)(18)(19)(20)(21)(22)(23)(24)(25); respectively (p=0.051). The incidence of severe complications in patients who survived and patients with early mortality was 34.1% and 63.6%; respectively (p=0.058).…”

“…For this reason, arterial complications may cause biliary ischemia that results in biliary strictures, bile leakage, and biloma. [19] Bile leakage constitutes 5-10% of early complications of transplantation. [2] Acute cellular rejection, another postoperative complication typically occurs within the first 90 days after transplantation, [2] and it causes high morbidity and mortality rates.…”

Relationship between postoperative biliary stricture and clinical characteristics of patients with benign and malignant biliary diseases.

“…; surgical procedures including but not limited to bile duct incision, exploration, stone removal, resection, suture, shaping, repairing and anastomosis, etc. ; (3) cases were confirmed as POBS by, among other things, symptoms, signs, various laboratory and imaging examinations (ultrasound, CT, MRCP, enhanced MR [ 13 ], ERCP, T-tube angiography, etc.) or secondary surgery.…”