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 pat...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2017-07-01
|
| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000686 |
| _version_ | 1818656422178586624 |
|---|---|
| author | Gerd Otto, MD Michael Heise, MD Jochen Thies, MD Michael Pitton, MD Jens Schneider, MD Gernot Kaiser, MD Peter Neuhaus, MD Otto Kollmar, MD Michael Barthels, MD Josef Geks, MD Wolf Otto Bechstein, MD Achim Hellinger, MD Jürgen Klempnauer, MD Winfried Padberg, MD Nils Frühauf, MD Andre Ebbing Dietmar Mauer, MD Astrid Schneider Robert Kwiecien Kai Kronfeld, MD |
| author_facet | Gerd Otto, MD Michael Heise, MD Jochen Thies, MD Michael Pitton, MD Jens Schneider, MD Gernot Kaiser, MD Peter Neuhaus, MD Otto Kollmar, MD Michael Barthels, MD Josef Geks, MD Wolf Otto Bechstein, MD Achim Hellinger, MD Jürgen Klempnauer, MD Winfried Padberg, MD Nils Frühauf, MD Andre Ebbing Dietmar Mauer, MD Astrid Schneider Robert Kwiecien Kai Kronfeld, MD |
| author_sort | Gerd Otto, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T03:25:20Z |
| format | Article |
| id | doaj.art-99e8c5a5bf114c418f65550bc9845f1e |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-17T03:25:20Z |
| publishDate | 2017-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-99e8c5a5bf114c418f65550bc9845f1e2022-12-21T22:05:25ZengWolters KluwerTransplantation Direct2373-87312017-07-0137e18310.1097/TXD.0000000000000686201707000-0009Liver 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 StudyGerd Otto, MD0Michael Heise, MD1Jochen Thies, MD2Michael Pitton, MD3Jens Schneider, MD4Gernot Kaiser, MD5Peter Neuhaus, MD6Otto Kollmar, MD7Michael Barthels, MD8Josef Geks, MD9Wolf Otto Bechstein, MD10Achim Hellinger, MD11Jürgen Klempnauer, MD12Winfried Padberg, MD13Nils Frühauf, MD14Andre Ebbing15Dietmar Mauer, MD16Astrid Schneider17Robert Kwiecien18Kai Kronfeld, MD191 Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.1 Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.1 Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.2 Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.2 Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.3 Department of General, Visceral and Transplantation Surgery, University Medical Center, Essen, Germany.4 Department of General, Visceral, Vascular and Thoracic Surgery, Charité, University Medical Center, Humboldt University, Berlin, Germany.5 Department of General, Visceral and Pediatric Surgery, University Medical Center, Georg August University, Göttingen, Germany.7 Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Medical Center, University of Leipzig, Germany.8 Department of Visceral, Thoracic and Vascular Surgery, University Medical Center, Philipp University, Marburg, Germany.9 Department of General and Visceral Surgery, University Medical Center, Johann Wolfgang Goethe University, Frankfurt, Germany.10 Department of General Surgery Medical Center, Fulda, Germany.11 General, Visceral and Transplant Surgery, Medical School Hannover, Germany.12 Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center, Justus Liebig University, Gießen, Germany.13 Deutsche Stiftung Organtransplantation, Region Nord Hannover, Germany.14 Deutsche Stiftung Organ Transplantation, Region Mitte Mainz, Germany.14 Deutsche Stiftung Organ Transplantation, Region Mitte Mainz, Germany.15 Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany.16 Institute of Biostatistics and Clinical Research, Westphalian Wilhelm University, Münster, Germany.17 Interdisciplinary Center for Clinical Trials Mainz and Surgical Trial Network; University Medical Center, Johannes Gutenberg University, Mainz, Germany.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.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000686 |
| spellingShingle | Gerd Otto, MD Michael Heise, MD Jochen Thies, MD Michael Pitton, MD Jens Schneider, MD Gernot Kaiser, MD Peter Neuhaus, MD Otto Kollmar, MD Michael Barthels, MD Josef Geks, MD Wolf Otto Bechstein, MD Achim Hellinger, MD Jürgen Klempnauer, MD Winfried Padberg, MD Nils Frühauf, MD Andre Ebbing Dietmar Mauer, MD Astrid Schneider Robert Kwiecien Kai Kronfeld, MD 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 Transplantation Direct |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000686 |
| work_keys_str_mv | AT gerdottomd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT michaelheisemd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT jochenthiesmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT michaelpittonmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT jensschneidermd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT gernotkaisermd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT peterneuhausmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT ottokollmarmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT michaelbarthelsmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT josefgeksmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT wolfottobechsteinmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT achimhellingermd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT jurgenklempnauermd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT winfriedpadbergmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT nilsfruhaufmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT andreebbing liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT dietmarmauermd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT astridschneider liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT robertkwiecien liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy AT kaikronfeldmd liverpreservationbyaorticperfusionalonecomparedwithpreservationbyaorticperfusionandadditionalarterialexsitubacktableperfusionwithhistidinetryptophanketoglutaratesolutionaprospectiverandomizedcontrolledmulticenterstudy |