Cag M, Audet M, Saouli A C, Panaro F, Piardi T, Cinqualbre J, Wolf P
Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, 1 avenue Molière, 67098 Strasbourg Cedex, France.
Transplant Proc. 2010 Nov;42(9):3630-3. doi: 10.1016/j.transproceed.2010.08.061.
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.
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.
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).
After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage.
在心脏死亡供体时代，许多报告涉及胆道并发症以及因胆道树独特的动脉血管化而对缺血再灌注损伤的担忧，热缺血时间被认为是器官获取期间胆道病变的原因。我们将动脉化时间定义为第二次热缺血时间。我们的目的是研究肝移植期间动脉化时间与胆道病变出现之间的相关性。
我们回顾性收集了过去5年原位肝移植的数据：即适应证、冷灌注液、冷缺血时间、手术操作时间和急性排斥事件。我们排除了劈离式肝移植、再次移植、儿科患者、胆汁淤积性疾病的移植、肝动脉血栓形成发生在胆道并发症之前的病例或移植后巨细胞病毒感染的患者。我们定义了两组：A）无胆道并发症；B）有胆道并发症。我们使用学生t检验比较平均动脉化时间，以确定植入期间的热缺血时间是否是胆道并发症的原因。P值<0.05被认为具有统计学意义。
在2004年至2008年底期间，我们为402例患者进行了移植，其中243例符合纳入标准：A组198例，B组45例。两组之间仅冷缺血时间有显著差异（P = 0.039）。
在无肝期之后，外科医生可以有时间进行动脉吻合，而不必担心胆道损伤增加。
