[Effect of anastomosis reconstruction on vascular complications after liver transplantation]

Besides primary non function (PNF), vascular complications are responsible for the majority of early surgical and interventional therapy following liver transplantation. The purpose of this study was to evaluate the influence of the variety of arterial anastomosis on postoperative morbidity and mortality. METHOD USED: In 179 liver transplantations, vascular (arterial and portal) complications within the first 3 months were analyzed with respect to the type of reconstruction. The arterial anastomoses were divided into 3 groups according to the recipient artery used [Group (I): common hepatic artery (CHA), (II): hepatic artery (HA), (III): aorta]. For statistical analysis comparison of two proportions and the logrank test were used.

The reconstruction was done primarily to the recipient CHA (69%, n = 124), less often to the HA (15%, n = 26) or directly to the aorta (16%, n = 29). The portal anastomosis-with the exception of two cases (dacron graft and internal iliac vein interposition)-was always end to end and resulted in four reinterventions (2.2%, kinking: n = 1, thrombosis: n = 3). Arterial complications (11.7%) like thrombosis, stenosis and dissection (n = 17), bleeding (n = 2) and steal phenomenon (n = 2) occurred more frequently. The difference in one year survival between patients with (n = 12/25, 47%) and without (n = 42/53, 79%) vascular complications was significant (chi 2 = 4.72, FG 1, logrank test p < 0.05).

The rate of complications causing surgical or interventional therapy is independent of the choice of arterial reconstruction. The one year survival rate in patients with vascular complications is significantly decreased.