Use of infrarenal conduits for arterial revascularization in orthotopic liver transplantation

Abstract

Arterial conduits that use donor iliac arteries represent a reliable technique for graft revascularization in orthotopic liver transplantation. We reviewed 757 consecutive liver transplantations performed between 1989 and 1995 for acute or chronic liver disease in adults and children. Of these, 218 patients received arterial conduits that used donor iliac arteries. The incidence of hepatic artery thrombosis (HAT) for conduits was 4.1% (9 of 218 patients) compared with 4% (22 of 539 patients) for direct arterial anastomosis. Patients in the arterial conduit group included 66% (99 of 159) of the children younger than 5 years of age, 75% (67 of 89) of all patients who underwent retransplantation, and, in particular, 25 patients regrafted for HAT. Arterial conduits provide an effective and reliable method of revascularization in patients at higher risk of arterial thrombosis. The actuarial 3-year patency rate for conduits is 95% and the incidence of HAT is similar to that in standard arterial anastomoses. Copyright 1998 by the American Association for the Study of Liver DiseasesH epatic artery thrombosis (HAT) remains an important cause of graft loss after liver transplantation. 1,2 Because the potential collateral supply to the graft is severed at the time of hepatectomy, the transplanted liver is particularly dependent on the arterial blood flow and HAT leads to retransplantation in up to 75% of patients, with a mortality rate approaching 50%. 3 Arterial conduits that use donor iliac arteries were developed to overcome arterial inflow problems, 4-6 and we have reviewed our experience with the use of this technique. MethodsWe reviewed 757 consecutive orthotopic liver transplantations (OLTs) performed between January 1989 and December 1995 for acute or chronic liver disease in adults and children. Of these, 218 grafts were revascularized by means of donor iliac artery anastomosed to the infrarenal aorta. These conduits were prepared from donor iliac arteries, occasionally from splenic artery, and exceptionally from saphenous vein, the latter being used for the initial living related liver transplantations. The common iliac arteries were retrieved at the end of the donor operation, carefully avoiding excessive traction to reduce the risk of intimal damage, and were stored in University of Wisconsin solution at 4°C.Whenever possible, iliac arteries from the same donors were used to construct the infrarenal conduit. Occasionally, these were unsuitable because of atherosclerosis or intimal damage, and we used the most recently retrieved ABO group-compatible vessels.The vascular grafts were prepared on the back table just before use and subsequently anastomosed to the infrarenal aorta, which was side-clamped by means of either an interrupted or a continuous 5/0 or 6/0 polypropylene suture. The graft was brought to the lesser sac through the transverse mesocolon, behind the stomach and in front of the pancreas. The distal end was subsequently anastomosed to the common hepatic artery or to the celiac trunk of the donor wit...

Liver transplantation in Indian Armed Forces—initial experience

“…12,13 In this series, six patients (18.7%) underwent seven extra-anatomic arterial conduits. Two vascular conduits were performed as graft salvage procedure following hepatic artery thrombosis (HAT) and the others underwent primary vascular conduits.…”

“…Ensuring integrity of the blood supply to the biliary tree, transecting the bile ducts along with the hilar plate and refinement in techniques of biliary anastomosis in LDLT has resulted in a significant reduction in the incidence of biliary complications from 24.3-40.6% before 2007 to 5. [3][4][5][6][7][8][9][10][11][12].8% in studies published after 2008 (Table 6). [27][28][29][30][31][32][33][34] Overall biliary complications in LDLT in our series was seen in three recipients (16.6%) which compares well with other studies.…”

Early vascular complications after pediatric liver transplantation

“…Two of the 8 patients who underwent immediate retransplantation died; 1 patient of recurrent HAT and 1 patient of neurological complications. Only 2 of 5 thrombectomies were (29) 72 (21) 72 (21) 65 (18) 62 (17) .0001 HAT (14) 86 (12) 86 (12) 86 (11) 78 (10) .07 PVT (7) 71 (5) 71 (5) 71 (5) 57 (4) .01 VOTO (7) 57 (4) 57 (4) 57 (4) (15) 13 (2) 13 (2) 13 (1) 13 (1) Ͻ.0001 PVT (7) 43 (3) 43 (3) 43 (3) 29 (2) .01 VOTO (10) 70 (7) 70 (7) 70 (7) 60 (6) .41…”

Small-bowel herniation under the infrarenal arterial conduit in a liver transplant recipient

“…1,2 Overall, complications related to the use of arterial grafts are rare and include conduit stenosis, chylous ascites, and pancreatitis. 2 Herniation of the small bowel under an infrarenal arterial conduit may result in ischemic necrosis of the entire small bowel and liver. In the present case, the initial redundancy of the aortic graft may have contributed to the formation of the internal hernia.…”

“…1,2 In this report, we present a rare complication associated with the use of an arterial conduit, which endangered the viability of the graft and the entire small bowel.…”