LIVING LIVER DONORS AND TECHNIQUES

U. Baccarani, A. Rossetto, D. Lorenzin, C. Musolino, C. Comuzzi, V. Bresadola, G.L. Adani
Surgery & Transplantation, University, Udine/ITALY

Body: Introduction: The sequence of liver reperfusion during liver transplantation (LT) is still a matter of debate. Aim of this study is to prospectively compare portal first (group 1) versus combined portal and arterial reperfusion (group 2) in heart-beating deceased donors LT. Methods: 38 patients were randomized 1:1 to group 1 or 2. No differences in the demographics characteristics (age 52±18 vs 54±12 p=0.98, male/female 14/5 for both groups) nor in indications to LT (viral hepatits 53% vs 47%, alcoholic hepatitis 32% vs 42%, others 15% vs 11%) were noted between group 1 and 2. Results (group 1 vs group 2): MELD was 17±7 vs 13±5 (p=0.11). Donor age was 52±18 vs 52±14 (p=0.98). Four grafts in each groups have macrosteatosis >15%. Duration of LT was 392±155 vs 370±62 min (p=0,49). Cold and warm ischemia times were respectively 478±147 vs 447±89 (p=0.43) and 37±7 vs 66±8 min (p<0.001). Units of blood transfused were 6±4 vs 7±4 (p=0.48). Plasma transfusion was 1300±1175 vs 2379±1959 ml (p=0.05). No PNF occurred in both groups. ICU stay was 7±4 vs 5±2 days (p=0.16). AST at day 1, 3 and 7 were 912±1745 vs 822±874 (p=0.84), 262±388 vs 259±219 (p=0.97) and 46±31 vs 38±21 (p=0.35), respectively. ALT at day 1, 3 and 7 were 621±1041 vs 754±807 (p=0.66), 493±763 vs 613±531 (p=0.57) and 130±180 vs 137±77 (p=0.94), respectively. Bilirubin was higher in group 2 at day +3 (2±2 vs 4±3 mg/dl, p=0.058) as gammaglutamyltransferase (97±81 vs 164±119, p=0.049). Creatinine was higher at day +3 in group 1 (1.41±0.86 vs 0.93±0.34 mg/dl, p=0.03). ICU postoperative stay was not different between the two groups being respectively 5±2 and 7±4 (p=0.16). Biopsy proven acute rejection requiring steroid pulse therapy accounted for 5% versus 10% (p=0.92) respectively in group 1 and 2. Biliary complications occurred in 31% vs 21% respectively in group 1 and 2 (p=0.46) at a mean follow-up 11±6 months. There were 1 thrombosis and 1 stenosis of the hepatic artery in group 1 vs none in group 2 (p=0.14). No portal vein complications occurred in both groups. One year estimated patient and graft’s survival were respectively 89% vs 94% and 94% vs 100% for group 1 and 2 (p=0.53). Conclusions: Contemporaneous portal and arterial reperfusion, although characterized by longer warm ischemia time, is not different from traditional portal reperfusion in terms of early graft function, vascular and biliary complications.

Disclosure: All authors have declared no conflicts of interest.