A SIMPLE MODIFICATION IN OPERATIVE TECHNIQUE CAN REDUCE THE INCIDENCEOF NONANASTOMOTIC BILIARY STRICTURES AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Nonanastomotic strictures after Liver transplantations are a source of significant morbidity, often necessitating transplantation. The purpo se of this study was twofold: first to identify features associated wi th the development of this lesion; second, to make technical modificat ions that will decrease the incidence of this problem. In the first pa rt of this study, 15 of 131 patients were diagnosed with nonanastomoti c biliary stricture. A stepwise logistic-regression analysis associate d donor cold ischemic time and dopamine dose with the development of n onanastomotic biliary strictures. All these patients had arterial reco nstruction after partial revascularization of the liver with portal ve nous blood. Because the bile duct receives its blood supply from only the hepatic artery, we hypothesized that the prolonged period of warm ischemia from staged reconstruction of the vascular supply would promo te the development of this lesion. In a second part of this study, the stricture rate in 45 patients with simultaneous revascularization usi ng both the hepatic artery and portal vein was compared with that in 8 3 patients from the first part of this study initially revascularized with portal venous blood. All patients in the second study had grafts preserved using UW solution. Only 1 patient with simultaneous revascul arization developed a nonanastomotic biliary stricture. Because we wer e unable to identify any significant complications related to this met hod of revascularization, we propose that the hepatic artery and porta l vein should be released simultaneously, especially in patients recei ving a graft with prolonged storage time.