Liver Transplantation Using Allografts With Hepatic Artery Injury During Procurement: A Propensity Score-Matched Analysis of Outcomes
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Published on: August 17, 2022
Florence Jeune1,2, Chetana Lim1,2,3, Éric Savier1,2,4
1Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
Insights
Hepatic artery injury during liver procurement is rare in deceased donor liver transplantation. This injury does not impact patient or graft survival, supporting a non-restrictive graft policy.
Area of Science:
- Transplantation Surgery
- Organ Procurement
- Vascular Reconstruction
Background:
- Hepatic artery (HA) injury during liver procurement is a significant concern in liver transplantation (LT).
- This study assessed the frequency and impact of HA injury in deceased donor liver transplantation (DDLT).
Purpose of the Study:
- To evaluate the incidence of HA injury during liver procurement in DDLT.
- To determine the impact of HA injury on short- and long-term outcomes following DDLT.
- To assess the association between aberrant HA anatomy and HA injury.
Main Methods:
- A single-center cohort study of adult DDLT recipients from 2010 to 2019.
- HA injury defined as section or ligation of arterial branches supplying the graft.
- Comparison of outcomes between grafts with HA injury (n=35) and without (n=677), using propensity score matching (PSM).
Main Results:
- HA injury occurred in 4.9% of grafts; aberrant HA anatomy was a significant predictor.
- Arterial reconstruction was needed in 53.8% of injured grafts.
- No significant differences in 90-day hepatic artery thrombosis (HAT), biliary complications, retransplantation, or 5-year patient and graft survival were observed between groups, even after PSM.
Conclusions:
- Hepatic artery injury during procurement is infrequent and does not adversely affect mid- or long-term liver transplant outcomes.
- Findings support a 'non-restrictive graft policy' for grafts with HA injury, optimizing organ utilization.
Background:
Hepatic artery (HA) injury during liver procurement is a significant concern in liver transplantation (LT). This study assessed its frequency and impact in deceased donor LT (DDLT).
Methods:
This was a single-center cohort study of adults who underwent DDLT from 2010 to 2019. HA injury was defined as the section or ligation of arterial branches supplying the graft. Recipients, donors' characteristics and outcomes of LTs using grafts with HA injury (group 1, n = 35) were compared to LTs using grafts without HA injury (group 2, n = 677). A propensity score matching (PSM) was applied. The primary endpoint was 90-day hepatic artery thrombosis (HAT); secondary endpoints included major biliary complications, retransplantation, patient, and graft-survival.
Results:
HA injury occurred in 4.9% of grafts. Aberrant HA anatomy was an independent predictive factor of HA injury (OR = 8.1 [3.7-17.9], p < 0.0001). Arterial reconstruction was required in 53.8% of injured grafts, while 23% had lateral sutures and 23% required no reconstruction. Arterial ischemia time was longer in group 1 (50 min [42-67] vs. 43 min [35-56]; p = 0.007). At 90-day, HAT (2.9% vs. 0.7%; p = 0.26), major biliary complications (5.7% vs. 7.2%, p>0.99) and retransplantation rates (2.9 % vs. 1%, p = 0.33) were similar. After PSM, theses outcomes remained comparable. The 5-year patient (74.3% vs. 78.3 %, p = 0.77) and graft-survival (70.2% vs. 75.6%, p = 0.78) were also similar.
Conclusion:
HA injury during procurement was rare and did not impact mid- or long-term LT outcomes, supporting a "non-restrictive graft policy" regarding grafts with HA injury.
