Twenty years of follow-up of aortohepatic conduits in liver transplantation

Abstract

Arterial problems remain a formidable challenge in liver transplantation. In many situations, an aortohepatic conduit can provide a solution. No long-term results (over 5 years) have been reported. This study was designed to assess the impact of aortohepatic conduits on graft survival after liver transplantation and the safety of aortohepatic conduits and to establish the long-term results (up to 20 years) of aortohepatic conduits. Data from 2346 adult liver transplants were prospectively collected into the computerized database and analyzed. In the majority of cases, arterial conduits were constructed from the donor iliac artery obtained at the liver retrieval. Aortohepatic conduits were required in 149 (6.4%) first transplants. The long-term graft survival after liver transplantation using aortohepatic conduits was excellent and comparable to that of the control group. The graft survival was 59% with the conduit versus 67% without the conduit at 5 years of follow-up, 50% versus 52% at 10 years, and 33% versus 35% at 15 years. With up to 20 years of follow-up, there was no statistically significant difference in graft survival, patient survival, hepatic artery complications, or biliary complications. For the same time period, there was no statistically significant difference in graft survival or patient survival for the retransplants with and without aortohepatic conduits. In conclusion, in experienced hands, aortohepatic conduits can be used safely for liver transplantation with no negative impact on long-term graft survival, patient survival, hepatic artery complications, or biliary complications. Excellent long-term results can be obtained.

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“…6,7 In comparison with other techniques, [8][9][10] such as the extra-anatomic aortohepatic conduit technique, results were better at our center, although not statistically different. This study is important because the Namazi Transplant Center in Shiraz (Iran) was the most crowded transplant center of the world during our study period, and we can now present our results to other centers.…”

Liver Transplantation Utilizing Mixed Biologic and Synthetic Arterial Conduits

“…Nikitin et al reported similar long-term survival for LT utilizing arterial conduits as compared to LT employing standard arterial reconstructions [1]. Although LT using arterial conduits can be performed safely in experienced hands, arterial conduits carry a potential for increased posttransplant complications and also higher rates of graft loss.…”

“…Arterial conduits are necessary in nearly 5% of all liver transplants [1, 2]. A segment of donor iliac artery usually is utilized as the arterial conduit, bridging recipient's infrarenal aorta to hepatic artery of the liver allograft (HAA) [3, 4].…”

Use of the subcutaneous route and polytetrafluoroethylene grafts for arterial revascularization in liver transplantation

“…1 In the majority of cases, donor iliac or carotid arteries are used as arterial conduits, and they are anastomosed to the infrarenal aorta as a source of inflow. 2 The original technique involves retropancreatic tunnelization anterior to the inferior vena cava (the short route) or to the left of the superior mesenteric artery (the long route). 3 Tzakis et al 4 later described the anterior route, in which the graft passes anterior to the pancreas but posterior to the stomach and colon; this offers the advantage of avoiding retroperitoneal dissection and retropancreatic varices.…”