Placement of an Aortohepatic Conduit as an Alternative to Standard Arterial Anastomosis in Liver Transplantation
Dong-Hwan Jung, Cheon-Soo Park, Tae-Yong Ha, Gi-Won Song, Gil-Chun Park, Yong-Pil Cho, Sung-Gyu Lee
Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
Ann Transplant 2018; 23:61-65
The aim of this study was to assess the impact of placement of an aortohepatic conduit on graft and patient survival after liver transplantation (LT) in selected patients with an inadequate recipient hepatic artery (HA) for a standard arterial anastomosis.
MATERIAL AND METHODS: Of 331 patients who underwent deceased donor LT, 25 (7.6%) who received placement of an aortohepatic conduit at the time of transplantation were included. Clinical characteristics and outcomes, including postoperative complications, conduit patency, and graft and patient survival rates, were analyzed.
RESULTS: All 25 patients included in this study presented a high preoperative Model for End-stage Liver Disease score (25.4±8.6; range, 6–42) and high rates of retransplantation (n=11, 44%) or previous abdominal – pelvic surgery (n=5, 20%). The observed postoperative vascular complications were portal vein thrombosis in 3 cases (12%) and anastomosis-site bleeding of the aortohepatic conduit in 1 case (4%); there was no HA thrombosis or stenosis in our analysis. With a median follow-up of 37 months (range, 0–69 months), all aortohepatic conduits were patent, and the graft and patient survival rates were 84% and 68%, respectively. The causes of death were graft failure (n=4), pneumonia (n=3), and cerebrovascular accidents (n=1).
CONCLUSIONS: Our results indicate that placement of an aortohepatic conduit is a feasible alternative to a standard arterial anastomosis in selected patients whose HA and surrounding potential inflow arteries are not suitable for standard arterial anastomosis.
Keywords: Graft Survival, Liver Diseases, Liver Transplantation