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Updated: Aug 26, 2025
Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Gastroduodenal artery disconnection during liver transplantation decreases non-anastomotic stricture incidence
Bi Pan1, Wei Liu1, Yan-Jiao Ou1
1Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Insights
Gastroduodenal artery (GDA) disconnection during liver transplantation (LT) reduces the incidence of biliary non-anastomotic stricture (NAS). This surgical approach may be beneficial in clinical practice for preventing post-transplant biliary complications.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Immunology
- Vascular Surgery
Background:
- The hepatic artery is crucial for biliary duct nourishment and is linked to complications after liver transplantation (LT).
- Gastroduodenal artery (GDA) disconnection is known to increase proper hepatic artery flow.
- The impact of GDA disconnection on preventing biliary non-anastomotic stricture (NAS) after LT remains unclear.
Purpose of the Study:
- To investigate whether GDA disconnection attenuates the incidence of biliary non-anastomotic stricture (NAS) following liver transplantation (LT).
- To identify risk factors associated with biliary NAS after LT.
- To compare postoperative complications and overall survival between patients who underwent GDA disconnection and those who did not.
Main Methods:
- Retrospective analysis of 241 patients undergoing LT, divided into GDA disconnection (GDA-) and GDA preservation (GDA+) groups.
- Propensity score matching (PSM) was used to minimize bias, creating 66 matched pairs.
- Logistic regression and Kaplan-Meier survival analysis were employed to assess risk factors and survival outcomes.
Main Results:
- GDA preservation was identified as a significant risk factor for biliary NAS (OR=2.24, P=0.025 before PSM; OR=3.15, P=0.014 after PSM).
- High Model for End-Stage Liver Disease (MELD) score (>15) was also a risk factor for NAS (OR=2.14, P=0.022 before PSM; OR=2.41, P=0.031 after PSM).
- GDA preservation was associated with a higher incidence of biliary NAS, while other complications and overall survival showed no significant differences.
Conclusions:
- GDA disconnection during LT is associated with a reduced incidence of biliary NAS.
- The findings suggest that GDA disconnection may be a valuable strategy to mitigate biliary complications after LT.
- This procedure could be recommended for clinical application to improve patient outcomes post-liver transplantation.
Background:
The hepatic artery is the only blood source nourishing the biliary duct and associated with biliary complication after liver transplantation (LT). Gastroduodenal artery (GDA) disconnection increased proper hepatic artery flow. Whether this procedure attenuates biliary non-anastomotic stricture (NAS) is not clear.
Methods:
A total of 241 patients with LT were retrospectively analyzed. The patients were divided into the GDA disconnection (GDA-) and GDA preservation (GDA+) groups. Propensity score matching (PSM) was administrated to reduce bias. Logistic regression was conducted to analyze risk factors for biliary NAS before and after PSM. Postoperative complications were compared. Kaplan-Meier survival analysis and log-rank tests were performed to compare overall survival.
Results:
In all, 99 patients (41.1%) underwent GDA disconnection, and 49 (20.3%) developed NAS. Multivariate logistic regression revealed that GDA preservation (OR = 2.24, 95% CI: 1.11-4.53; P = 0.025) and model for end-stage liver disease (MELD) score > 15 (OR = 2.14, 95% CI: 1.12-4.11; P = 0.022) were risk factors for biliary NAS. PSM provided 66 pairs using 1:2 matching method, including 66 GDA disconnection and 99 GDA preservation patients. Multivariate logistic regression after PSM also showed that GDA preservation (OR = 3.15, 95% CI: 1.26-7.89; P = 0.014) and MELD score > 15 (OR = 2.41, 95% CI: 1.08-5.36; P = 0.031) were risk factors for NAS. When comparing complications between the two groups, GDA preservation was associated with a higher incidence of biliary NAS before and after PSM (P = 0.031 and 0.017, respectively). In contrast, other complications including early allograft dysfunction (P = 0.620), small-for-size graft syndrome (P = 0.441), abdominal hemorrhage (P = 1.000), major complications (Clavien-Dindo grade ≥ 3, P = 0.318), and overall survival (P = 0.088) were not significantly different between the two groups.
Conclusions:
GDA disconnection during LT ameliorates biliary NAS incidence and may be recommended for application in clinical practice.
