Department of Liver Transplant and Hepato Pancreato Biliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
Transplantation. 2018 Apr;102(4):e155-e162. doi: 10.1097/TP.0000000000002088.
In live donor liver transplantation portal flush only of the graft is done on the bench. There are no data on antegrade arterial flush along with portal flush of the graft.
Consecutive patients undergoing elective right lobe live donor liver transplantation were block-randomized to receive either portal flush only or both portal and antegrade arterial flush. The primary objectives were safety, rate of early allograft dysfunction (EAD), and impact on vascular and biliary complications.
After randomization, there were 40 patients in each group. Both groups had comparable preoperative, intraoperative, and donor variables. There were no adverse events related to arterial flushing. The portal and antegrade arterial flush group had significantly lower postoperative bilirubin on days 7, 14, and 21 (all P < 0.05), EAD (P = 0.005), intensive care unit/high dependency unit (P = 0.01), and hospital stay (P = 0.05). This group also had lower peak aspartate aminotransferase (P = 0.07), alanine aminotransferase (P = 0.06) and lower rates of sepsis (P = 0.08) trending toward statistical significance. Portal and antegrade arterial flush groups had lower ascitic fluid drainage and in-hospital mortality. Arterial and biliary complications were not statistically different in the 2 groups. Multivariate analysis of EAD showed portal with antegrade arterial flush was associated with lower rate (P = 0.007), whereas model for end-stage liver disease Na (P = 0.01) and donor age (P = 0.03) were associated with a higher rate of EAD.
Portal with antegrade arterial flushing of right lobe live liver grafts is safe, significantly decreases postoperative cholestasis, EAD, intensive care unit/high dependency unit, and hospital stay and is associated with lower rates of sepsis, ascitic drainage and inhospital mortality in comparison to portal flush only.
在活体肝移植中，仅在手术台上对供体进行门静脉冲洗。目前尚无关于供体门静脉冲洗联合顺行动脉冲洗的数据。
连续选择行择期右半肝活体肝移植的患者，按区组随机分为仅门静脉冲洗组或门静脉和顺行动脉冲洗组。主要研究终点为安全性、早期移植物功能障碍（EAD）发生率以及对血管和胆漏并发症的影响。
随机分组后，每组各 40 例患者。两组患者的术前、术中及供者相关变量均无差异。动脉冲洗无不良事件发生。门静脉和顺行动脉冲洗组患者术后第 7、14 和 21 天的胆红素水平显著更低（均 P < 0.05），EAD 发生率更低（P = 0.005），入住 ICU/HDU 时间更短（P = 0.01），住院时间更短（P = 0.05）。该组患者的天冬氨酸转氨酶（P = 0.07）、丙氨酸转氨酶峰值（P = 0.06）也更低，败血症发生率更低（P = 0.08），但差异无统计学意义。门静脉和顺行动脉冲洗组的腹水引流量和院内死亡率更低。两组的血管和胆漏并发症发生率无差异。EAD 的多因素分析显示，门静脉联合顺行动脉冲洗与较低的发生率相关（P = 0.007），而终末期肝病模型钠（P = 0.01）和供者年龄（P = 0.03）与 EAD 发生率较高相关。
与仅门静脉冲洗相比，门静脉联合顺行动脉冲洗右半肝活体供肝是安全的，可显著降低术后胆汁淤积、EAD、入住 ICU/HDU 时间和住院时间，败血症、腹水引流和院内死亡率也更低。
