Vascular Anomalies of the Extrahepatic Artery as a Predictable Risk Factor for Complications After Liver Transplant

Teegen, Eva Maria; Globke, Brigitta; Denecke, Timm; Pascher, Andreas; Öllinger, Robert; Pratschke, Johann; Chopra, Sascha

doi:10.6002/ect.2018.0201

Cited by 3 publications

(8 citation statements)

References 15 publications

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“…[ 1–8 ] Despite heterogenous data in the literature, [ 1–8,20,21 ] it has been usually reported that the use of grafts with vascular anomalies does not intrinsically increase LT morbidity, but results in complex vascular reconstructions that may predispose to arterial and biliary complications due to long graft vessels, multiple anastomosis, and hemodynamic disturbances. [ 1–5 ] Moreover, increasing age and cardiovascular/metabolic comorbidities of both donors and recipients in contemporary clinical practice are inevitably associated with worse quality of arteries to be reconstructed. Therefore, a pragmatic surgical strategy for graft arterial revascularization should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of graft arterial anomalies on LT outcomes has a complex and multifactorial pathogenesis, depending on size and quality of aberrant vessels, extension of physiologic perfusion territory, anatomical availability of a compensatory arterial network, type of arterial reconstruction, and potential additional warm ischemia time. [1][2][3][4][5][6][7][8] Despite heterogenous data in the literature, [1][2][3][4][5][6][7][8]20,21] it has been usually reported that the use of grafts with vascular anomalies does not intrinsically increase LT morbidity, but results in complex vascular reconstructions that may predispose to arterial and biliary complications due to long graft vessels, multiple anastomosis, and hemodynamic disturbances. [1][2][3][4][5] Moreover, increasing age and cardiovascular/metabolic comorbidities of both T A B L E 2 Graft arterial anatomy and type of vascular reconstruction used for aHA…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Overall, the reported prevalence of HA variations in the general population ranges from 19% to 49%. [1,4] Arterial anastomosis on back table or during graft implantation may require complex, challenging, and time-consuming procedures. Those reconstructions frequently result in long graft vessels with turbulent flow, which are inherently associated with an increased risk of complications.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] By contrast, concerns for appropriate blood supply of the graft biliary tree have commonly resulted in recommendations for a strictly preserving approach with reconstruction of all aberrant arteries whenever technically feasible. [1,[3][4][5][6][7][8] aRHAs and aLHAs may be either replaced or accessory, according to the absence or presence of an homolateral branch from the proper HA. [1,9] However, such information may not be readily available at the time of LT, because contrast-enhanced computed tomography (CT) scan is not a routine examination in most deceased donor assessment protocols.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

et al. 2022

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In liver transplantation (LT), graft aberrant hepatic arteries (aHAs) frequently require complex arterial reconstructions, potentially increasing the risk of post-operative complications. However, intrahepatic hilar arterial shunts are physiologically present and may allow selective aHA ligation. Thus, we performed a retrospective study from a single-center cohort of 618 deceased donor LTs where a selective reconstruction policy of aHAs was prospectively applied. In the presence of any aHA, the vessel with the largest caliber was first reconstructed. In case of adequate bilobar arterial perfusion assessed on intraparenchymal Doppler ultrasound, the remnant vessel was ligated; otherwise, it was reconstructed. Consequently, outcomes of three patient groups were compared: the "no aHAs" group (n = 499), the "reconstructed aHA" group (n = 25), and the "ligated aHA" group (n = 94). Primary endpoint was rate of biliary complications. Only 38.4% of right aHAs and 3.1% of left aHAs were reconstructed. Rates of biliary complications in the no aHA, reconstructed aHA, and ligated aHA groups were 23.4%, 28%, and 20.2% (p = 0.667), respectively. The prevalence rates of primary non-function (p = 0.534), early allograft dysfunction (p = 0.832), and arterial complications (p = 0.271), as well as patient survival (p = 0.266) were comparable among the three groups. Retransplantation rates were 3.8%, 4%, and 5.3% (p = 0.685), respectively. In conclusion, a selective reconstruction policy of aHAs based on Doppler assessment of bilobar intraparenchymal arterial flow did not increase post-operative morbidity and avoided unnecessary and complex arterial reconstructions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

et al. 2022

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“…In a retrospective analysis of 323 transplants, authors failed to show an association between variant donor arterial anatomy and complications or survival. [ 14 ] In another retrospective analysis of 200 transplantations authors concluded that both recipient vascular complications and donor complications were not associated with donor vascular variations. [ 15 ] Similar studies with cadaveric grafts showed no difference between variant and normal donor arterial anatomy in terms of recipient survival.…”

Section: Discussionmentioning

confidence: 99%

Living liver donor hilar anatomical variations and impact of variant anatomy on transplant outcomes

et al. 2022

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Donor anatomy is an essential part of donor selection and operative planning in living donor liver transplantation. In this study, variations of hilar structures, and the effects of variant anatomy on donor and recipient outcomes were evaluated. Living donor liver transplantations in a single center between January 2013 and December 2020 were retrospectively reviewed. In total, 203 liver transplantations were analyzed. Type 1 arterial anatomy, type 1 portal vein anatomy and type 1 bile duct anatomy were observed in 144 (70.9%), 173 (85.2%), and 129 (63.5%) donors, respectively. Variant biliary anatomy was observed more frequent in donors with variant portal vein branching than in those with type 1 portal anatomy (60.0% vs 32.3%, P = .004). The overall survival rates calculated for each hilar structure were similar between recipients receiving grafts with type 1 anatomy and those receiving grafts with variant anatomy. When donors with variant anatomy and donors with type 1 anatomy were compared in terms of hilar structure, no significant difference was observed in the frequency of complications and the frequency of serious complications. Biliary variations are more common in individuals with variant portal vein anatomy. Donor anatomic variations are not risk factors for inferior results of recipient survival or donor morbidity.

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Complicaciones vasculares postrasplante hepático, una situación con alta morbimortalidad

Tarazona-León,

Vanegas-Ballesteros,

Vergara

et al. 2024

Rev Colomb Cir

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Introducción. El trasplante hepático es el tratamiento indicado en aquellas enfermedades del hígado en las cuales ya se han agotado otras medidas terapéuticas, y es un procedimiento complejo. Las complicaciones postquirúrgicas se relacionan con alta morbimortalidad y pueden llevar a desenlaces fatales; las complicaciones vasculares son las de mayor mortalidad, por lo que es crucial la detección temprana y el tratamiento oportuno. El objetivo de este estudio fue caracterizar los pacientes que presentaron complicaciones vasculares posterior a trasplante hepático. Métodos. Estudio descriptivo, retrospectivo, con seguimiento a los pacientes sometidos a trasplante hepático en la Fundación Cardiovascular, entre los años 2013 y 2023, que presentaron complicaciones vasculares. Se evaluó el tipo de complicación, los factores de riesgo y los desenlaces postquirúrgicos. Resultados. Se incluyeron en total 82 pacientes trasplantados, con un predominio del sexo masculino 59,8 % (n=49); la principal indicación del trasplante fue el alcoholismo (21,9 %). Veinte pacientes presentaron complicaciones vasculares; la más frecuente fue trombosis de arteria hepática, en el 45 % (n=9). En tres de estos casos se requirió nuevo trasplante. Conclusión. Las complicaciones vasculares empeoran la evolución clínica postoperatoria de los pacientes y están relacionadas con alta morbimortalidad, por lo cual es crucial la valoración multidisciplinaria, el diagnóstico oportuno y la intervención temprana para disminuir los desenlaces fatales.

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Vascular Anomalies of the Extrahepatic Artery as a Predictable Risk Factor for Complications After Liver Transplant

Cited by 3 publications

References 15 publications

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

Living liver donor hilar anatomical variations and impact of variant anatomy on transplant outcomes

Complicaciones vasculares postrasplante hepático, una situación con alta morbimortalidad

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