Division of HPB Surgery & Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center Rotterdam, the Netherlands.
Surgery. 2020 Jul;168(1):160-166. doi: 10.1016/j.surg.2020.02.005. Epub 2020 Mar 26.
Donor hepatectomy time is associated with graft survival after liver transplantation. The aim of this study was to identify the impact of donor hepatectomy time on biliary injury during donation after circulatory death liver transplantation.
First, bile duct biopsies of livers included in (pre)clinical machine perfusion research were analyzed. Secondly, of the same livers, bile samples were collected during normothermic machine perfusion. Lastly, a nationwide retrospective cohort study was performed including 273 adult patients undergoing donation after circulatory death liver transplantation between January 1, 2002 and January 1, 2017. Primary endpoint was development of non-anastomotic biliary strictures within 2 years of donation after circulatory death liver transplantation. Cox proportional-hazards regression analyses were used to assess the influence of hepatectomy time on the development of non-anastomotic biliary strictures.
Livers with severe histological bile duct injury had a higher median hepatectomy time (P = .03). During normothermic machine perfusion, livers with a hepatectomy time >50 minutes had lower biliary bicarbonate and bile pH levels. In the nationwide retrospective study, donor hepatectomy time was an independent risk factor for non-anastomotic biliary strictures after donation after circulatory death liver transplantation (Hazard Ratio 1.18 per 10 minutes increase, 95% Confidence Interval 1.06-1.30, P value = .002).
Donor hepatectomy time negatively influences histological bile duct injury before normothermic machine perfusion and bile composition during normothermic machine perfusion. Additionally, hepatectomy time is a significant independent risk factor for the development of non-anastomotic biliary strictures after donation after circulatory death liver transplantation.
供体肝切除术时间与肝移植后移植物存活率有关。本研究旨在确定供体肝切除术时间对体外循环死亡后肝移植中胆损伤的影响。
首先，分析包括在（预）临床机器灌注研究中的肝脏胆管活检。其次，在常温机器灌注期间，从同一肝脏中收集胆汁样本。最后，进行了一项全国性回顾性队列研究，纳入 2002 年 1 月 1 日至 2017 年 1 月 1 日期间接受体外循环死亡后肝移植的 273 例成年患者。主要终点是在体外循环死亡后肝移植后 2 年内发生非吻合性胆狭窄。使用 Cox 比例风险回归分析评估肝切除术时间对非吻合性胆狭窄发展的影响。
组织学胆管损伤严重的肝脏肝切除时间中位数较高（P=0.03）。在常温机器灌注期间，肝切除时间>50 分钟的肝脏胆汁碳酸氢盐和胆汁 pH 值较低。在全国性回顾性研究中，供体肝切除术时间是体外循环死亡后肝移植后发生非吻合性胆狭窄的独立危险因素（每增加 10 分钟的风险比为 1.18，95%置信区间为 1.06-1.30，P 值=0.002）。
供体肝切除术时间在常温机器灌注前对组织学胆管损伤和常温机器灌注期间的胆汁成分有负面影响。此外，肝切除术时间是体外循环死亡后肝移植后发生非吻合性胆狭窄的重要独立危险因素。
