LIVING LIVER DONORS AND TECHNIQUES

F. Ulrich¹, S. Kohler¹, W.P. Hofmann², C. Sarrazin², S. Zeuzem², W.O. Bechstein¹, C. Mönch^1
1Dept. Of General And Visceral Surgery, J.W. Goethe University Frankfurt, Frankfurt/GERMANY, ²Dept. Of Gastroenterology And Hepatology, J.W. Goethe University Frankfurt, Frankfurt/GERMANY

Body: Introduction: The reperfusion technique (simultaneous versus sequential portal-arterial) during orthotopic liver transplantation (OLT) is still a matter of controversial debate regarding therisk of ischemic type biliary lesions (ITBL). To date there is no data concerning arterial first reperfusion (sequential arterial-portal).

Methods: This prospective trial comparing arterial first reperfusion (AFR) versus portal first reperfusion (PFR) during OLT was performed from 01/2007 to11/2009. All OLT were performed in piggy-back technique with the use of a temporary portocaval shunt. In the PFR group the graft was flushed with 500 ml blood after completion of the portal veinanastomosis and before sewing of the arterial anastomosis. In the AFR group portal vein and arterial anastomosis were performed before flushing the artery for two minutes. The portal vein was flushedthereafter; altogether the graft was flushed with 500 ml of blood as well. The bile duct was reconstructed end-to-end. Immunosuppression consisted of basiliximab induction and a steroid-freemaintenance therapy with tacrolimus and MMF.

Results: n=110 OLT were included in the trial. All grafts were preserved with HTK solution. 61 patients (age 54.4 +/- 8.7, 72% male, MELD 26.8 +/- 6) belongedto the PFR group (01/2007 - 08/2008), while 49 patients (age 54.7 +/- 8.3, 73% male, MELD 28.1 +/- 7) were included in the AFR group (09/2008 - 06/2009). Cold ischemia time, donor age, indication forOLT, rejection and CMV rates as well as patient and graft survival were comparable in both groups. Warm ischemia time was significantly (p<0.05) lower in the PFR group (33.2 +/- 7 minutes versus38.7 +/- 5 minutes). Reasons for re-OLT in 2 patients were PNF in one patient (PFR group) and one case of arterial thrombosis (AFR group). ITBL was observed in 11 patients in the PFR group (18.1%)versus 3 patients in AFR group (6.1%). This difference was highly significant (p<0.001).

Conclusion: Arterial first reperfusion is highly effective in the prevention of ischemic type biliary lesions. This might be explained by the initial flush withoxygenated blood without pressure in the portal vein.

Disclosure: All authors have declared no conflicts of interest.