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Study of the arterial and bile duct blood flow during liver transplantation

Abstract

Liver transplantation is the outstanding treatment for end-stage liver disease. Post transplant biliary complications, despite improvement efforts in surgery and organ preservation, remains at 11-35% rates, and causes significant morbidity and mortality. A better look the blood perfusion of the bile duct in the liver transplant may be helpful in overcome this challenge.The liver has double blood supply, the hepatic artery and portal vein. But the biliary epithelium is supplied mainly by the arterial flow and is more vulnerable than the hepatocyte to ischemia/reperfusion injury. Ischemic lesions of the biliary tract may occur in liver transplantation markedly due to hepatic artery thrombosis, but may occur with hepatic artery stenosis or even due to ischemia / reperfusion injury. Vascularization of the bile duct is made by a vascular plexus with many small arteries, mainly by the 3 and 9 o'clock arteries. The very tip point of the distal biliary stump and lower bile graft stump, probably less vascularized areas of the two systems are used for biliary anastomosis in liver transplant. This reveals the importance of the blood flow of the bile duct and explains the high incidence of biliary disease in liver transplantation.The so-called " steal flow syndrome" by the gastroduodenal artery has been reported in the literature in series or case reports in patients with persistently elevated liver enzymes, malfunction graft, cholestasis or hepatic artery thrombosis. However, the concept of the syndrome is not widely accepted and its impact on liver transplantation remains uncertain.Assess the impact of the ligation of the gastroduodenal artery during the liver transplant, in the blood flow of the graft hepatic artery and the bile duct stump of the graft and the recipient stump is the goal of this study. In the study, performing the anastomosis to downstream of the gastroduodenal artery, measurement of blood flow of the hepatic artery graft will be performed with and without clamping of the gastroduodenal artery. The blood flow measurement is performed using the Medtronic Medi-Stim AS Inc device. After measuring the arterial blood flow will be held blood flow measured in the bile duct of the graft and the distal bile duct stump of the recipient before the preparation of the biliary anastomoses with or without clamping of the gastroduodenal artery, just as was described for the study of the flow of hepatic artery. (AU)

Articles published in Agência FAPESP Newsletter about the research grant: