LAUSR

We read the article by Kim et al, 1 which was recently published in Transplantation, with great interest. In the study, the authors found that HA flow lower than 400 mL/min was associated with an increased rate of biliary strictures in younger donors (<50 years) and in patients with duct-to-duct anastomoses (P = 0.028). Lower HA flow was also associated with decreased graft survival (P = 0.013). Nevertheless, only donor age and HCC as the primary diagnosis were related to biliary strictures in the first 24 months based on multivariate analysis. HA flow lower than 400mL/minwas associated with biliary strictures (hazard ratio, 1.53; 95% confidence interval, 1.04-2.24; P = 0.0297) but only in univariate and not multivariate analysis. In addition, HA flow lower than 400 mL/min was also related to graft failure in univariate analysis. The authors conclude that increasing HA flow in patients receiving grafts from younger donors and with low HA flows should be considered. Recently, we conducted a retrospective observational study over a prospective database analyzing 333 consecutive orthotopic liver transplants performed between January 2007 and October 2012. Two groups were established per HA flow (216 patients with HA flow <200 mL/min and 117 patients with HA flow ≥200 mL/min). Lower HA flow