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Published on: November 7, 2020
How to Handle Arterial Conduits in Liver Transplantation? Evidence From the First Multicenter Risk Analysis
Christian E Oberkofler1, Dimitri A Raptis1,2, Joseph DiNorcia3
1Swiss HPB & Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Insights
Arterial conduits (AC) in liver transplantation (LT) are a viable rescue option. Conduit placement site did not impact outcomes, but antiplatelet therapy after LT significantly improved graft survival in this high-risk group.
Area of Science:
- Hepatology
- Transplantation Surgery
- Vascular Surgery
Background:
- Arterial conduits (AC) serve as a critical rescue strategy in liver transplantation (LT) when standard arterial reconstruction is not feasible.
- Optimal placement and the role of antiplatelet therapy for ACs in LT remain incompletely understood.
Purpose of the Study:
- To identify independent risk factors for arterial conduit occlusion post-liver transplantation.
- To compare the outcomes associated with different arterial conduit placement sites.
- To determine the protective effect of postoperative antiplatelet therapy.
Main Methods:
- An international, multicenter cohort study involving 14 LT centers from 2007 to 2016.
- Included 565 adult deceased donor LT cases requiring AC.
- Primary endpoint: arterial occlusion/patency; Secondary endpoints: perioperative outcomes, graft and patient survival.
Main Results:
- Early occlusion (≤30 days) occurred in 8% of cases.
- Primary patency was similar across supraceliac, infrarenal, and iliac conduit placements.
- Independent risk factors for early occlusion included donor age >40, coronary artery bypass, and lack of aspirin post-LT.
- Graft survival was significantly higher in patients receiving antiplatelet therapy.
Conclusions:
- Conduit placement site appears to have minimal impact on outcomes in LT requiring AC, suggesting surgeon preference is key.
- Postoperative antiplatelet therapy is supported as a beneficial strategy in LT patients requiring arterial conduits.
Objective:
The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective.
Background:
Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature.
Study Design:
This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2007 to December 2016. Primary endpoint was arterial occlusion/patency. Secondary endpoints included intra- and perioperative outcomes and graft and patient survival.
Results:
The cohort was composed of 565 LT. Infrarenal aortic placement was performed in 77% of ACs whereas supraceliac placement in 20%. Early occlusion (≤30 days) occurred in 8% of cases. Primary patency was equivalent for supraceliac, infrarenal, and iliac conduits. Multivariate analysis identified donor age >40 years, coronary artery bypass, and no aspirin after LT as independent risk factors for early occlusion. Postoperative antiaggregation regimen differed among centers and was given in 49% of cases. Graft survival was significantly superior for patients receiving aggregation inhibitors after LT.
Conclusion:
When AC is required for rescue graft revascularization, the conduit placement site seems to be negligible and should follow the surgeon's preference. In this high-risk group, the study supports the concept of postoperative antiaggregation in LT requiring AC.
