Liver preservation by aortic perfusion alone compared with preservation by aortic perfusion and additional arterial ex situ back-table perfusion with histidine-tryptophan-ketoglutarate solution : a prospective, randomized, controlled, multicenter study

  • Background. Arterial ex situ back-table perfusion (BP) reportedly reduces ischemic-type biliary lesion after liver transplantation. We aimed to verify these findings in a prospective investigation. Methods. Our prospective, randomized, controlled, multicenter study involved livers retrieved from patients in 2 German regions, and compared the outcomes of standard aortic perfusion to those of aortic perfusion combined with arterial ex situ BP. The primary endpoint was the incidence of ischemic-type biliary lesions over a follow-up of 2 years after liver transplantation, whereas secondary endpoints included 2-year graft survival, initial graft damage as reflected by transaminase levels, and functional biliary parameters at 6 months after transplantation. Results. A total of 75 livers preserved via standard aortic perfusion and 75 preserved via standard aortic perfusion plus arterial BP were treated using a standardized protocol. The incidence of clinically apparent biliary lesions after liver transplantation (n = 9 for both groups; P = 0.947), the 2-year graft survival rate (standard aortic perfusion, 74%; standard aortic perfusion plus arterial BP, 68%; P = 0.34), and incidence of initial graft injury did not differ between the 2 perfusion modes. Although 33 of the 77 patients with cholangiography workups exhibited injured bile ducts, only 10 had clinical symptoms. Conclusions. Contrary to previous findings, the present study indicated that additional ex situ BP did not prevent ischemic-type biliary lesions or ischemia-reperfusion injury after liver transplantation. Moreover, there was considerable discrepancy between cholangiography findings regarding bile duct changes and clinically apparent cholangiopathy after transplantation, which should be considered when assessing ischemic-type biliary lesions.

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Author:Gerd Otto, Michael Heise, Jochen Thies, Michael Pitton, Jens Schneider, Gernot Kaiser, Peter Neuhaus, Otto Kollmar, Michael Barthels, Josef Geks, Wolf Otto Bechstein, Achim Hellinger, Jürgen Klempnauer, Winfried Padberg, Nils Frühauf, Andre Ebbing, Dietmar Mauer, Astrid Schneider, Robert Kwiecien, Kai Kronfeld
Pubmed Id:
Parent Title (English):Transplantation direct
Publisher:Wolters Kluwer Health
Place of publication:London
Document Type:Article
Year of Completion:2017
Date of first Publication:2017/06/26
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2017/11/21
Issue:7, e183
Page Number:7
First Page:1
Last Page:7
Copyright © 2017 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0