Abstract
Propose: The impact of arterial ex-situ back-table perfusion on ischemic type biliary lesions (ITBL) after liver transplantation was investigated. Method: Between October 2007 and March 2010, 299 consecutively retrieved livers were included in a prospective randomized controlled multi-center study to compare aortal perfusion (group A) with aortal perfusion plus additional arterial ex situ back-table perfusion (group B). Randomization was performed after hepatectomy during organ procurement. The grafts were shipped to 14 participating centers in Germany. Primary end point was the occurrence of ITBL 6 months after liver transplantation as demonstrated clinically and by bile duct imaging (ERCP or MRI). Secondary end points were initial liver function and ischemia reperfusion injury. Results: Two hundred ninety-nine grafts were randomized. Out of them 264 were allocated and transplanted in the participating centers. For a preliminary evaluation, data sets of 155 (group A: n=76, group B: n=79) patients and results of imaging of 71 patients were available. Age and gender of donors and recipients, cold and warm ischemia time were identical in group A and B. Mortality and retransplantation rate were comparable (p=0.348 and p=0.357, respectively). The rates of clinically ITBL apparent after 6 months were 12% and 14% (p=0.832), those of radiologically apparent lesions 40% and 46% (p=0.407). Development of ITBL was marginally influenced by cold (p=0.06) and warm (p=0.05) ischemia time but not by donor age, transaminases, gamma-glutamyltransreferase, bilirubin, use of norepinephrine in the donor, ICU stay and MELD score. Laboratory parameters in recipients were identical irrespective of the mode of perfusion. Conclusion: Ex- situ back table perfusion neither prevents ischemic type biliary lesions nor does it affect initial liver function and ischemia reperfusion injury after liver transplantation.
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