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Updates in Surgery

, Volume 64, Issue 3, pp 173–177 | Cite as

Protection of the intrahepatic biliary tree by contemporaneous portal and arterial reperfusion: results of a prospective randomized pilot study

  • Umberto Baccarani
  • Anna Rossetto
  • Dario Lorenzin
  • Stefania Bidinost
  • Maria Laura Pertoldeo
  • Manuela Lugano
  • Vittorio Bresadola
  • Giorgio Della Rocca
  • Andrea Risaliti
  • Gian Luigi Adani
Original Article

Abstract

Sequential portal and arterial revascularization (SPAr) is the most common method of graft reperfusion at liver transplantation (LT), contemporaneous portal and arterial revascularization (CPAr) was used to reduce arterial ischemia to the bile ducts. Aim of this pilot study is to prospectively compare SPAr (group 1 #38) versus CPAr (group 2 #42) in 80 consecutive LTs. Biliary anastomosis was always duct to duct [T-tube in 21 % of cases (p = 0.83) in both groups]. CPAr had longer warm ischemia 61 ± 10 versus 39 ± 13 min, p < 0.0001, while SPAr had longer arterial ischemia 96 ± 39 min (p = 0.0001). No PNF while DGF was encountered in 10 versus 5 % (p = 0.32). One-year graft and patient’s survival were respectively 87 versus 93 % and 83 versus 88 % in groups 1 and 2 (p = 0.31 and p = 0.39). At a median follow-up of 19 ± 8 versus 17 ± 8 months (p = 0.24), biliary complications were 28 %, being 39 % in group 1 and 19 % in group 2 (p = 0.04). Anastomotic stenoses were present in 11 versus 12 % (p = 0.84), biliary leakage in 5 versus 5 % (p = 0.72) and intrahepatic non-anastomotic biliary strictures in 23 versus 0 % (p = 0.0008) in groups 1 and 2. CPAr is safe and feasible and reduces the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia to the intrahepatic bile ducts.

Keyword

Bile ducts Biliary strictures Hepatic artery Ischemia Liver transplantation Portal vein Reperfusion 

Notes

Conflict of interest

None.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Umberto Baccarani
    • 1
  • Anna Rossetto
    • 1
  • Dario Lorenzin
    • 1
  • Stefania Bidinost
    • 1
  • Maria Laura Pertoldeo
    • 1
  • Manuela Lugano
    • 2
  • Vittorio Bresadola
    • 1
  • Giorgio Della Rocca
    • 2
  • Andrea Risaliti
    • 1
  • Gian Luigi Adani
    • 1
  1. 1.Liver Transplant Unit, Department of Medical and Biological SciencesUniversity of UdineUdineItaly
  2. 2.The Institute of Anesthesiology and Intensive Care UnitUniversity HospitalUdineItaly

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