Adani G L, Rossetto A, Lorenzin D, Lugano M, De Anna D, Della Rocca G, Donini A, Bresadola V, Risaliti A, Baccarani U
Department of Surgery & Transplantation, University Hospital, Udine, Italy.
Transplant Proc. 2011 May;43(4):1107-9. doi: 10.1016/j.transproceed.2011.01.123.
Although sequential portal and arterial revascularization (SPAr) is the most common method of graft reperfusion at liver transplantation (OLT), contemporaneous portal and hepatic artery revascularization (CPAr) has been used to reduce arterial ischemia to the bile ducts. The aim of this study was to prospectively compare SPAr (group 1; n=19) versus CPAr (group 2; n=21) among 40 consecutive OLT from heart-beating donors. There were no differences in the demographics characteristics, Model for End-stage Liver Disease scores, indication for OLT and donor parameters between the groups. OLT was performed using the piggyback technique. The biliary anastomosis was performed in all cases by a duct-to-duct technique with a T-tube in 32% versus 29% of cases without a T tube (P=.83). In the CPAr group, the liver was reperfused simultaneously via the portal vein and hepatic artery. CPAr showed a longer warm ischemia (66 ± 8 vs 37 ± 7 minutes; P<.001), while SPAr had a longer arterial ischemia 103 ± 42 vs 66 ± 8 minutes (P=.0004). Recovery of graft function was similar. There was no primary nonfunction and delayed graft function occurred among 10% versus 9%. Liver function tests were similar between the two groups up to 90 days case of follow-up- One-year graft and patient survivals were, respectively, 89% and 95% versus 94% and 100% (P=.29). At a median follow-up of 13 ± 6 versus 14 ± 7 months, biliary complications included anastomotic stenoses in 15% versus 19% (P=.78) and intrahepatic non-anastomotic biliary strictures in 26% versus none (P=.01) for SPAr and CPAr, respectively. CPAr was safe and feasible, reducing the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia to the intrahepatic bile ducts.
尽管序贯门静脉和动脉血运重建（SPAr）是肝移植（OLT）时移植物再灌注最常用的方法，但同期门静脉和肝动脉血运重建（CPAr）已被用于减少胆管的动脉缺血。本研究的目的是对40例来自心脏跳动供体的连续OLT患者进行前瞻性比较，对比SPAr组（第1组；n = 19）和CPAr组（第2组；n = 21）。两组在人口统计学特征、终末期肝病模型评分、OLT指征和供体参数方面无差异。OLT采用背驮式技术进行。所有病例均采用端端吻合技术进行胆管吻合，32%的病例放置T管，29%的病例未放置T管（P = 0.83）。在CPAr组中，肝脏通过门静脉和肝动脉同时进行再灌注。CPAr显示出更长的热缺血时间（66±8分钟对37±7分钟；P < 0.001），而SPAr的动脉缺血时间更长（103±42分钟对66±8分钟；P = 0.0004）。移植物功能恢复情况相似。无原发性无功能发生，延迟性移植物功能发生率分别为10%和9%。两组在随访90天内肝功能检查相似。1年移植物和患者生存率分别为89%和95%对94%和100%（P = 0.29）。在中位随访时间13±6个月对14±7个月时，胆管并发症包括SPAr组和CPAr组的吻合口狭窄分别为15%和19%（P = 0.78），肝内非吻合口胆管狭窄分别为26%和无（P = 0.01）。CPAr安全可行，通过减少肝内胆管的动脉缺血时间降低了肝内胆管狭窄的发生率。
