Antegrade hepatic artery and portal vein perfusion versus portal vein perfusion alone in live donor liver transplantation: a randomized trial.
Shaji Mathew, J., Kumar, K. Y. S. et al. (2019).Liver Transplantation 25: 25.
Aims
This study aimed to determine the effects of antegrade hepatic artery perfusion during live donor liver transplantation (LDLT).
Interventions
Donor hepatectomy patients were randomised to receive graft perfusion of Histidine-tryptophan-ketoglutarate (HTK) solution either through dual perfusion using both the hepatic artery and portal vein, or standard perfusion, only through the portal vein.
Participants
123 live donor liver transplant patients (>18 years; LDLT from Nov 2015-March 2017).
Outcomes
Primary outcomes were assessed as Biliary stricture and Biliary Leak. These outcomes were measured as biliary obstruction on MR cholangiography, biliary obstruction on endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography, or intrahepatic biliary radical dilatation on ultrasonography. Secondary outcomes included hepatic artery thrombosis, portal vein and hepatic venous vascular issues, such as thrombosis/stenosis, intra-operative parameters, such as mean arterial pressure, post-operative hospital stay, graft and patient survival rates and liver function tests immed
Follow-up
30.2 months.
CET Conclusions
This is a good quality RCT in live donor liver transplantation comparing two methods of perfusion: Dual (hepatic artery and portal vein) or single (portal vein only) perfusion. There was a significant reduction in biliary stricture in the study group from approximately 20% to 6% (p=0.04). There was no significant difference in hepatic artery thrombosis or biliary leak. The study was not powered to see a difference in hepatic artery thrombosis, which was a safety concern for the arterial perfusion, however, HAT was actually numerically less in the study group than control group. The 3-year graft survival was significantly better in the dual perfusion group than the single portal perfusion group (approximately 95% versus 77%, p=0.003). A soft catheter was used for arterial perfusion, a 14F paediatric aortic root cannula to minimise any potential trauma to the intima.
Data analysis
Strict intention-to-treat analysis
Trial registration
Clinical Trials Registry of India - CTRI/2015/11/006398