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

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

doi:10.1097/TXD.0000000000000686

Transplantation Direct (Jul 2017)

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

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

Affiliations

Gerd Otto, MD: 1 Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Michael Heise, MD: 1 Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Jochen Thies, MD: 1 Department of Transplantation and Hepatobiliary Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Michael Pitton, MD: 2 Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Jens Schneider, MD: 2 Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Gernot Kaiser, MD: 3 Department of General, Visceral and Transplantation Surgery, University Medical Center, Essen, Germany.
Peter Neuhaus, MD: 4 Department of General, Visceral, Vascular and Thoracic Surgery, Charité, University Medical Center, Humboldt University, Berlin, Germany.
Otto Kollmar, MD: 5 Department of General, Visceral and Pediatric Surgery, University Medical Center, Georg August University, Göttingen, Germany.
Michael Barthels, MD: 7 Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Medical Center, University of Leipzig, Germany.
Josef Geks, MD: 8 Department of Visceral, Thoracic and Vascular Surgery, University Medical Center, Philipp University, Marburg, Germany.
Wolf Otto Bechstein, MD: 9 Department of General and Visceral Surgery, University Medical Center, Johann Wolfgang Goethe University, Frankfurt, Germany.
Achim Hellinger, MD: 10 Department of General Surgery Medical Center, Fulda, Germany.
Jürgen Klempnauer, MD: 11 General, Visceral and Transplant Surgery, Medical School Hannover, Germany.
Winfried Padberg, MD: 12 Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center, Justus Liebig University, Gießen, Germany.
Nils Frühauf, MD: 13 Deutsche Stiftung Organtransplantation, Region Nord Hannover, Germany.
Andre Ebbing: 14 Deutsche Stiftung Organ Transplantation, Region Mitte Mainz, Germany.
Dietmar Mauer, MD: 14 Deutsche Stiftung Organ Transplantation, Region Mitte Mainz, Germany.
Astrid Schneider: 15 Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Robert Kwiecien: 16 Institute of Biostatistics and Clinical Research, Westphalian Wilhelm University, Münster, Germany.
Kai Kronfeld, MD: 17 Interdisciplinary Center for Clinical Trials Mainz and Surgical Trial Network; University Medical Center, Johannes Gutenberg University, Mainz, Germany.

DOI: https://doi.org/10.1097/TXD.0000000000000686
Journal volume & issue: Vol. 3, no. 7
p. e183

Abstract

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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.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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