Biliary Complications Clinical Trial
Official title:
Antegrade Arterial and Portal Flushing Versus Portal Flushing Only of the Liver Graft in Living Donor Liver Transplantation and Its Effects on Biliary Complications and Graft Function: A Randomized Control Study
Arterial flushing is a standard recommendation in deceased donor liver transplantation but not in living donor liver transplantation due to the risk of arterial intimal injury and short cold ischaemia time. There is recent evidence on benefit of retrograde arterial perfusion using hepatic venous occlusion and its benefits on post transplant cholestasis. However there is no data on antegrade arterial flushing.
Biliary reconstruction has been labeled the "Achilles heel" of liver transplantation and is
a common cause of postoperative morbidity and also mortality .Living donor liver
transplantation (LDLT) has a higher incidence of biliary complications of up to 30% which is
higher than Deceased Donor Liver Transplantation and does not seem to improve significantly
with experience.The virtually unchanged incidence of biliary strictures suggests that they
are not simply "technical" in origin, but probably represent a mucosa ischemic injury
inherent in the transplantation procedure. The blood supply of the bile duct is mainly from
the arterial system and skeletonisation of the duct during dissection impairs the blood
supply rendering it ischemic.
Various donor maneuvers for better flushing and preserving peribiliary vascular plexus and
biliary mucosa have been studied to decrease biliary complications. LDLT have advantages of
haemodynamic stable donor and short cold ischemia but also has disadvantages of small graft
size, small ducts, complicated reconstruction and absence of arterial flush. Conventional
portal flush in animal livers could not remove warm blood from the arterial system and
grafts without retrograde arterial flush had higher post operative bilirubin.With further
studies in Living Donor Liver Transplant, it was concluded that retrograde flushing may
ameliorate post operative cholestasis. There has not been data published on antegrade
arterial flushing and its effect on biliary complications in Living Donor Liver Transplant.
This study aims to compare back table graft arterial and portal flushing with portal
flushing alone and evaluate biliary and arterial complications.
Arterial flushing has been made part of standard protocol at our institute and its safety
established. There are centers which routinely perform back table arterial flush.
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Status | Clinical Trial | Phase | |
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Recruiting |
NCT01829139 -
Efficacy of Choleretics in Acalculous Gallbladder in Situ After Endoscopic Removal of Biliary Stones
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N/A |