Low Measured Hepatic Artery Flow Increases Rate of Biliary Strictures in Deceased Donor Liver Transplantation
| Autor: | Peter T. W. Kim, Richard Ruiz, Giovanna Saracino, Nicholas Onaca, Amar Gupta, Goran B. Klintmalm, Gregory J. McKenna, Tiffany Anthony, Michael A. E. Ramsay, Giuliano Testa, Hoylan Fernandez |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Age dependent Kaplan-Meier Estimate 030230 surgery Anastomosis Liver transplantation Gastroenterology 03 medical and health sciences Hepatic Artery 0302 clinical medicine Risk Factors Cause of Death Internal medicine medicine Humans Retrospective Studies Cause of death Transplantation Deceased donor Chi-Square Distribution Cholestasis Bile duct business.industry Anastomosis Surgical Graft Survival Age Factors Middle Aged Tissue Donors Liver Transplantation Biliary Tract Surgical Procedures Treatment Outcome medicine.anatomical_structure Regional Blood Flow Multivariate Analysis Female 030211 gastroenterology & hepatology Graft survival business Blood Flow Velocity Artery |
| Zdroj: | Transplantation. 101:332-340 |
| ISSN: | 0041-1337 |
| Popis: | This study was conducted to determine effect of lower measured hepatic arterial (HA) flow (400 mL/min) on biliary complications and graft survival after deceased donor liver transplantation. Hepatic artery is the main blood supply to bile duct and lack of adequate HA flow is thought to be a risk factor for biliary complications.A retrospective review of 1300 patients who underwent deceased donor liver transplantation was performed. Patients with arterial complications were excluded to eliminate potential contribution to biliary complications from HA thrombosis. Patients were divided into low (400 mL/min; N = 201) and high (≥400 mL/min; N = 1099) HA flow groups. Incidence of biliary complications and graft survival were analyzed.HA flows less than 400 mL/min were associated with increased rate of biliary strictures in younger donors (50 years old), and in patients with duct-to-duct anastomoses (P = 0.028). Lower HA flows were associated with decreased graft survival (P = 0.013). Donor older than 50 years was associated with increased rate of biliary strictures (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.14-2.45; P = 0.0085) and graft failure (HR, 1.68; 95% CI, 1.35-2.1; P0.0001) on multivariate analyses. HA flow less than 400 mL/min was associated with biliary strictures (HR, 1.53; 95% CI, 1.04-2.24; P = 0.0297) on univariate analysis only.HA flow less than 400 mL/min was associated with higher rate of biliary strictures in younger donors with duct-to-duct reconstruction and lower graft survival. A consideration should be given to increase the intraoperative HA flow to prevent biliary strictures in such patients. |
| Databáze: | OpenAIRE |
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