An Arterial Conduit is Not a Risk Factor for Survival Following Orthotopic Liver Transplantation: An Analysis of 20 Years of Liver Transplantation in Innsbruck
Christian Denecke, Sascha Weiss, Matthias Biebl, Josef Fritz, Tomasz Dziodzio, Felix Aigner, Robert Sucher, Andreas Brandl, Claudia Bösmüller, Johann Pratschke, Robert Öllinger
Department of General, Visceral and Transplantation Surgery, Charite Universitätsmedizin, Berlin, Germany
Ann Transplant 2016; 21:321-328
Available online: 2016-05-24
In adult liver transplantation, arterial conduits have been associated with increased risk for vascular complications and inferior outcome.
MATERIAL AND METHODS: Complication rates and outcomes of adult patients undergoing liver transplantation in our center between 1990 and 2012 were analyzed retrospectively. Characteristics, transplantation-related factors, and survival rates of patients with conduit grafts (n=43) were compared to patients with a standard arterial anastomosis (n=904) by univariate and multivariate analysis.
RESULTS: Patients in the conduit group were younger but had a significantly higher proportion of high-urgency and re-transplantations. While patient survival was comparable between the groups, graft survival was inferior for patients with a conduit (1-year, 5-year, and 10-year survival, control vs. conduit group: 87.3%, 78.8% and 71.5% vs. 72.4%, 63.8%, and 41.8%, respectively, p=0.008). In univariate analysis, an arterial conduit was associated with more arterial and biliary complications. However, an arterial conduit was not an independent risk factor for graft or patient survival in a Cox regression analysis.
CONCLUSIONS: An arterial conduit is associated with more vascular complications, yet a conduit per se does not influence graft survival. The inferior outcome may reflect the complex situation of the sicker liver transplant patients needing a non-standard arterial anastomosis.
Keywords: Anastomosis, Surgical, Liver Transplantation, Patient Outcome Assessment