Shahbazov Rauf, Azari Feredun, Xu Thomas, Saracino Giovanna, Maluf Daniel, Pelletier Shawn J
From the Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA.
Exp Clin Transplant. 2021 Jul;19(7):671-675. doi: 10.6002/ect.2020.0555. Epub 2021 Apr 29.
Although initial portal vein reperfusion of a liver allograft is nearly standardized, limited data suggest initial hepatic artery reperfusion may improve hemodynamics and posttransplant outcomes.
We retrospectively reviewed orthotopic liver transplants performed between January 2013 and February 2018. Parameters of liver recipients with initial hepatic artery reperfusion were compared with those with initial portal vein reperfusion.
Of 204 recipients, 53 (26%) were initially perfused from the hepatic artery and 151 (74%) were initially perfused from the portal vein. Demographics between groups did not differ. There were no significant differences in the incidence of acute rejection between recipients with initial hepatic artery reperfusion versus portal vein reperfusion at 3 months and 1 year (1.9% vs 7.9% and 7.5% vs 10.6%; not significant), hepatic artery thrombosis (1.9% vs 4.0% and 1.9% vs 7.3%; not significant), biliary leakage (7.5% vs 4.0% and 9.4 vs 6.6; not significant), biliary strictures (7.5% vs 5.3% and 11.3% vs 7.9%; not significant), or portal or hepatic venous thrombosis/stenosis (5.7% vs 5.3% and 7.5% vs 7.9%; not significant). Furthermore, recipients with initial hepatic artery reperfusion and portal vein reperfusion were both hospitalized for a median of 8.5 days (interquartile range, 6.5-15.5 vs 7.0-14.0 days, respectively), and both groups were in the intensive care unit for a median of 3 days (interquartile range, 2-7 vs 2-4 days, respectively). Initial hepatic artery reperfusion was associated with significantly less intraoperative packet red blood cell transfusion (median, 11.9 U [interquartile range, 11.1-13.1 U] vs 15.5 U [interquartile range, 12.9-17.9 U]; P < .001). The 2 groups did not differ in terms of patient and graft survival.
Initial reperfusion of liver allografts with arterial, rather than portal, blood has benefits to hemodynamic stability, did not have deleterious effects on outcomes, and resulted in less intraoperative blood utilization.
尽管肝移植初始门静脉再灌注已接近标准化，但有限的数据表明初始肝动脉再灌注可能改善血流动力学和移植后结局。
我们回顾性分析了2013年1月至2018年2月期间进行的原位肝移植。将初始肝动脉再灌注的肝移植受者参数与初始门静脉再灌注的受者参数进行比较。
在204例受者中，53例（26%）初始从肝动脉灌注，151例（74%）初始从门静脉灌注。两组间人口统计学特征无差异。初始肝动脉再灌注与门静脉再灌注的受者在3个月和1年时急性排斥反应发生率（1.9%对7.9%和7.5%对10.6%；无统计学意义）、肝动脉血栓形成（1.9%对4.0%和1.9%对7.3%；无统计学意义）、胆漏（7.5%对4.0%和9.4%对6.6%；无统计学意义）、胆管狭窄（7.5%对5.3%和11.3%对7.9%；无统计学意义）或门静脉或肝静脉血栓形成/狭窄（5.7%对5.3%和7.5%对7.9%；无统计学意义）方面均无显著差异。此外，初始肝动脉再灌注和门静脉再灌注的受者住院时间中位数均为8.5天（四分位间距分别为6.5 - 15.5天和7.0 - 14.0天），两组在重症监护病房的时间中位数均为3天（四分位间距分别为2 - 7天和2 - 4天）。初始肝动脉再灌注与术中红细胞输注量显著减少相关（中位数，11.9单位[四分位间距，11.1 - 13.1单位]对15.5单位[四分位间距，12.9 - 17.9单位]；P <.001）。两组在患者和移植物生存率方面无差异。
肝移植初始用动脉血而非门静脉血进行再灌注对血流动力学稳定性有益，对结局无不良影响，且术中血液利用率较低。
