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

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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.

Original languageEnglish
Pages (from-to)173-177
Number of pages5
JournalUpdates in Surgery
Volume64
Issue number3
DOIs
Publication statusPublished - Sep 2012

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Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Baccarani, U., Rossetto, A., Lorenzin, D., Bidinost, S., Pertoldeo, M. L., Lugano, M., Bresadola, V., Rocca, G. D., Risaliti, A., & Adani, G. L. (2012). Protection of the intrahepatic biliary tree by contemporaneous portal and arterial reperfusion: Results of a prospective randomized pilot study. Updates in Surgery, 64(3), 173-177. https://doi.org/10.1007/s13304-012-0164-1