| Is impaired hepatic arterial buffer response a risk factor for biliary anastomotic stricture in liver transplant recipients? | |
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MedLine Citation:
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PMID: 20227098 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Blood flow to the liver is partly maintained by the hepatic arterial buffer response (HABR), which is an intrinsic autoregulatory mechanism. Temporary clamping of the portal vein (PV) results in augmentation in hepatic artery flow (augHAF). Portal hyperperfusion impairs HAF due to the HABR in liver transplantation (LT). The aim of this study is to examine the effect of the HABR on biliary anastomotic stricture (BAS). METHODS: In 234 cadaveric whole LTs, PV flow (PVF), basal HAF, and augHAF were measured intra-operatively after allograft implantation. All recipients with a vascular complication were excluded. Buffer capacity (BC) was calculated as (augHAF - basal HAF)/PVF to quantify the HABR. Recipients were divided into 2 groups based on their BC: low BC (<0.074; n = 117) or high BC (> or =0.074; n = 117). RESULTS: Of the 234 recipients, 23 (9.8%) had early BAS (< or =60 days after LT) and 18 (7.7%) had late BAS (>60 days after LT). The incidence of late BAS and bile leakage was similar between the groups; however, the incidence of early BAS in the low BC group was greater than that in the high BC group (15% vs 5.1%; P = .0168). In the multivariate analysis, low BC (P = .0325) and bile leakage (P = .0002) were found to be independent risk factors affecting early BAS. CONCLUSION: Recipients with low BC who may have impaired HABR are at greater risk of early BAS after LT. Intraoperative measurements of blood flow help predict the risk of BAS. |
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Authors:
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Koji Hashimoto; Charles M Miller; Cristiano Quintini; Federico N Aucejo; Kenzo Hirose; Teresa Diago Uso; Loris Trenti; Dympna M Kelly; Charles G Winans; David P Vogt; Bijan Eghtesad; John J Fung |
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Publication Detail:
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Type: Journal Article Date: 2010-03-15 |
Journal Detail:
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Title: Surgery Volume: 148 ISSN: 1532-7361 ISO Abbreviation: Surgery Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-19 Completed Date: 2010-09-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: United States |
Other Details:
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Languages: eng Pagination: 582-8 Citation Subset: AIM; IM |
Copyright Information:
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Published by Mosby, Inc. |
Affiliation:
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Department of Hepato-Pancreato-Biliary and Transplant Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA. hashimk@ccf.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Arteriovenous Fistula / epidemiology, etiology* Bile / secretion Blood Flow Velocity Cadaver Cardiac Output Constriction, Pathologic / epidemiology, etiology* Female Follow-Up Studies Hepatic Artery / physiopathology* Homeostasis Humans Liver Transplantation / adverse effects* Male Middle Aged Patient Selection Portal Vein / physiopathology Postoperative Complications / epidemiology Regression Analysis Retrospective Studies Risk Factors Tissue Donors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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