%0 Journal Article
%T Timing of Hepatic Artery Reperfusion and Biliary Strictures in Liver Transplantation
%A Ganesh Gunasekaran
%A Jyoti Sharma
%A Leandro C. Mosna
%A Roxana Bodin
%A David C. Wolf
%J Journal of Transplantation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/757389
%X During orthotopic liver transplantation (OLT), biliary tract perfusion occurs with hepatic artery reperfusion (HARP), commonly performed after the portal vein reperfusion (PVRP). We examined whether the average time interval between PVRP and HARP impacted on postoperative biliary strictures occurrence. Patients undergoing OLT from 2007 to 2009 were included if they were ¡Ý18 years old, had survived 3 months postoperatively, and had data for PVRP and HARP. Patients receiving allografts from DCD donors were excluded. Patients were followed for 6 months post-OLT. Seventy-five patients met the study inclusion criteria. Of these, 10 patients had a biliary stricture. There was no statistical difference between those with and without biliary stricture in age, gender, etiology, MELD score, graft survival, and time interval between PVRP and HARP. Ninety percent of patients with biliary stricture had a PVRP-HARP time interval >30 minutes, as opposed to 77% of patients without biliary stricture. However, this was not statistically significant. The cold ischemia time was significantly different between the two groups. Time interval for HARP after PVRP did not appear to affect the development of biliary strictures. However, 30 minutes may be suggested as a critical time after which there is an increase in biliary stricture occurrence. 1. Introduction Orthotopic liver transplantation (OLT) remains the gold standard for treatment of end-stage liver disease (ESLD) despite advances in medical treatment and management of complications [1]. Surgically, OLT involves hepatectomy followed by implantation. Implantation includes reestablishment of three critical structures: the portal vein, the hepatic artery, and the biliary duct in a sequential fashion. Most often, hepatic artery reperfusion (HARP) occurs after portal vein reperfusion (PVRP) and establishes the blood supply to the bile duct epithelium. Postoperative biliary complications may be attributable to hepatic artery thrombosis or stenosis, technical reasons, ischemia-reperfusion injury, and immunological injury. Most common biliary complications include stricture, leak, biloma, and biliary abscess. These complications can be early, those occurring less than 30 days after OLT, or late, those occurring after 30 days [2]. Biliary complications secondary to long warm ischemia times, independent of vascular compromise, have been reported in the literature specifically in recipients who received livers from donation after cardiac death (DCD) donors [3¨C6]. Ischemic cholangiopathy has been described in 9¨C50% of DCD
%U http://www.hindawi.com/journals/jtrans/2013/757389/