Otto Gerd, Heise Michael, Thies Jochen, Pitton Michael, Schneider Jens, Kaiser Gernot, Neuhaus Peter, Kollmar Otto, Barthels Michael, Geks Josef, Bechstein Wolf Otto, Hellinger Achim, Klempnauer Jürgen, Padberg Winfried, Frühauf Nils, Ebbing Andre, Mauer Dietmar, Schneider Astrid, Kwiecien Robert, Kronfeld Kai
Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Transplant Direct. 2017 Jun 26;3(7):e183. doi: 10.1097/TXD.0000000000000686. eCollection 2017 Jul.
Arterial ex situ back-table perfusion (BP reportedly reduces ischemic-type biliary lesion after liver transplantation. We aimed to verify these findings in a prospective investigation.
Our prospective, randomized, controlled, multicenter study involved livers retrieved from patients in 2 German regions, and compared the outcomes of standard aortic perfusion to those of aortic perfusion combined with arterial ex situ BP. The primary endpoint was the incidence of ischemic-type biliary lesions over a follow-up of 2 years after liver transplantation, whereas secondary endpoints included 2-year graft survival, initial graft damage as reflected by transaminase levels, and functional biliary parameters at 6 months after transplantation.
A total of 75 livers preserved via standard aortic perfusion and 75 preserved via standard aortic perfusion plus arterial BP were treated using a standardized protocol. The incidence of clinically apparent biliary lesions after liver transplantation (n = 9 for both groups; = 0.947), the 2-year graft survival rate (standard aortic perfusion, 74%; standard aortic perfusion plus arterial BP, 68%; = 0.34), and incidence of initial graft injury did not differ between the 2 perfusion modes. Although 33 of the 77 patients with cholangiography workups exhibited injured bile ducts, only 10 had clinical symptoms.
Contrary to previous findings, the present study indicated that additional ex situ BP did not prevent ischemic-type biliary lesions or ischemia-reperfusion injury after liver transplantation. Moreover, there was considerable discrepancy between cholangiography findings regarding bile duct changes and clinically apparent cholangiopathy after transplantation, which should be considered when assessing ischemic-type biliary lesions.
据报道，动脉体外背台灌注（BP）可降低肝移植术后缺血型胆管病变的发生率。我们旨在通过一项前瞻性研究来验证这些发现。
我们的前瞻性、随机、对照、多中心研究纳入了从德国两个地区的患者获取的肝脏，并将标准主动脉灌注的结果与主动脉灌注联合动脉体外BP的结果进行比较。主要终点是肝移植术后2年随访期间缺血型胆管病变的发生率，次要终点包括2年移植物存活率、转氨酶水平反映的初始移植物损伤以及移植后6个月的功能性胆管参数。
共有75例通过标准主动脉灌注保存的肝脏和75例通过标准主动脉灌注加动脉BP保存的肝脏采用标准化方案进行处理。肝移植后临床明显胆管病变的发生率（两组均为9例；P = 0.947）、2年移植物存活率（标准主动脉灌注为74%；标准主动脉灌注加动脉BP为68%；P = 0.34）以及初始移植物损伤的发生率在两种灌注方式之间没有差异。尽管77例接受胆管造影检查的患者中有33例显示胆管受损，但只有10例有临床症状。
与先前的发现相反，本研究表明，额外的体外BP并不能预防肝移植术后的缺血型胆管病变或缺血再灌注损伤。此外，移植后胆管造影检查发现的胆管变化与临床明显的胆管病之间存在相当大的差异，在评估缺血型胆管病变时应予以考虑。
