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      Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation--a randomized clinical trial.

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          Abstract

          Initial nonfunction (INF) and biliary complications such as ischemic-type biliary lesion (ITBL) remain two major complications in clinical orthotopic liver transplantation (OLT). The influence of ischemia and reperfusion injury (I/R) as a significant risk factor for both complications is widely unquestioned. A new reperfusion technique that reduces I/R injury should lead to a reduction in both INF and ITBL. One hundred and thirty two OLT patients were included in this study and randomized into two groups. Group A underwent standard reperfusion with anterograde simultaneous arterial and portal reperfusion and group B received retrograde reperfusion via the vena cava before sequential anterograde reperfusion of portal vein and hepatic artery. Serum transaminase level as a surrogate parameter for I/R injury and serum bilirubin level as a parameter for graft function were significantly reduced during the first week after OLT in group B. INF rate was 7.7% in group A and 0% in group B (P = 0.058). ITBL incidence was 4.55% in group A versus 12.3% in group B (P = 0.053). Retrograde reperfusion seemed to be beneficial for hepatocytes, but was detrimental for the biliary epithelium. The unexplained increased incidence of ITBL after retrograde reperfusion will be focus of further investigation.

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          Author and article information

          Journal
          Transpl. Int.
          Transplant international : official journal of the European Society for Organ Transplantation
          Wiley-Blackwell
          0934-0874
          0934-0874
          Sep 2006
          : 19
          : 9
          Affiliations
          [1 ] Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Universitätsmedizin Berlin, Berlin, Germany. christoph.heidenhain@charite.de
          Article
          TRI347
          10.1111/j.1432-2277.2006.00347.x
          16918535
          d0825613-a45f-4ea0-98c3-db2c2749a9b0
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