Pan Bi, Liu Wei, Ou Yan-Jiao, Zhang Yan-Qi, Jiang Di, Li Yuan-Cheng, Chen Zhi-Yu, Zhang Lei-Da, Zhang Cheng-Cheng
Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Hepatobiliary Pancreat Dis Int. 2023 Feb;22(1):28-33. doi: 10.1016/j.hbpd.2022.09.013. Epub 2022 Sep 30.
The hepatic artery is the only blood source nourishing the biliary duct and associated with biliary complication after liver transplantation (LT). Gastroduodenal artery (GDA) disconnection increased proper hepatic artery flow. Whether this procedure attenuates biliary non-anastomotic stricture (NAS) is not clear.
A total of 241 patients with LT were retrospectively analyzed. The patients were divided into the GDA disconnection (GDA-) and GDA preservation (GDA+) groups. Propensity score matching (PSM) was administrated to reduce bias. Logistic regression was conducted to analyze risk factors for biliary NAS before and after PSM. Postoperative complications were compared. Kaplan-Meier survival analysis and log-rank tests were performed to compare overall survival.
In all, 99 patients (41.1%) underwent GDA disconnection, and 49 (20.3%) developed NAS. Multivariate logistic regression revealed that GDA preservation (OR = 2.24, 95% CI: 1.11-4.53; P = 0.025) and model for end-stage liver disease (MELD) score > 15 (OR = 2.14, 95% CI: 1.12-4.11; P = 0.022) were risk factors for biliary NAS. PSM provided 66 pairs using 1:2 matching method, including 66 GDA disconnection and 99 GDA preservation patients. Multivariate logistic regression after PSM also showed that GDA preservation (OR = 3.15, 95% CI: 1.26-7.89; P = 0.014) and MELD score > 15 (OR = 2.41, 95% CI: 1.08-5.36; P = 0.031) were risk factors for NAS. When comparing complications between the two groups, GDA preservation was associated with a higher incidence of biliary NAS before and after PSM (P = 0.031 and 0.017, respectively). In contrast, other complications including early allograft dysfunction (P = 0.620), small-for-size graft syndrome (P = 0.441), abdominal hemorrhage (P = 1.000), major complications (Clavien-Dindo grade ≥ 3, P = 0.318), and overall survival (P = 0.088) were not significantly different between the two groups.
GDA disconnection during LT ameliorates biliary NAS incidence and may be recommended for application in clinical practice.
肝动脉是肝脏移植（LT）后滋养胆管且与胆道并发症相关的唯一血供来源。胃十二指肠动脉（GDA）离断可增加肝固有动脉血流。该操作是否能减轻胆管非吻合口狭窄（NAS）尚不清楚。
回顾性分析241例LT患者。将患者分为GDA离断组（GDA-）和GDA保留组（GDA+）。采用倾向评分匹配（PSM）以减少偏倚。进行逻辑回归分析PSM前后胆管NAS的危险因素。比较术后并发症。采用Kaplan-Meier生存分析和对数秩检验比较总生存率。
共有99例患者（41.1%）接受了GDA离断，49例（20.3%）发生了NAS。多因素逻辑回归显示，GDA保留（OR = 2.24，95%CI：1.11 - 4.53；P = 0.025）和终末期肝病模型（MELD）评分>15（OR = 2.14，95%CI：1.12 - 4.11；P = 0.022）是胆管NAS的危险因素。PSM采用1:2匹配方法提供了66对，包括66例GDA离断患者和99例GDA保留患者。PSM后的多因素逻辑回归也显示，GDA保留（OR = 3.15，95%CI：1.26 - 7.89；P = 0.014）和MELD评分>15（OR = 2.41，95%CI：1.08 - 5.36；P = 0.031）是NAS的危险因素。比较两组并发症时，PSM前后GDA保留均与胆管NAS的较高发生率相关（分别为P = 0.031和0.017）。相比之下，两组之间其他并发症包括早期移植物功能障碍（P = 0.620）、小体积移植物综合征（P = 0.441）、腹腔出血（P = 1.000）、严重并发症（Clavien-Dindo分级≥3，P = 0.318）和总生存率（P = 0.088）无显著差异。
LT期间GDA离断可改善胆管NAS发生率，可能推荐在临床实践中应用。
