BACK-TABLE ARTERIAL RECONSTRUCTION IN LIVER TRANSPLANTATION: SINGLE CENTRE EXPERIENCE Istituto di Chirurgia Sperimentale, dei Trapianti e Cardiovascolare Università degli Studi di Milano Unità Operativa Complessa: Centro Trapianto di Fegato e Polmone Ospedale Maggiore IRCCS Direttore Prof. L. R. Fassati Ernesto MELADA, Umberto MAGGI, Giorgio ROSSI, Lucio CACCAMO, Stefano GATTI, Giovanni PAONE, Paolo REGGIANI, Emilietta BRIGATI, Luigi Rainero FASSATI 11th ANNUAL INTERNATIONAL CONGRESS - I.L.T.S - LOS ANGELES JULY 20-23, 2005
AIM OF STUDY • To evaluate the rate of arterial variants of hepatic supply and of different types of variants • To review our arterial reconstructions in LT • To test a relationship between arterial reconstructions and hepatic artery thrombosis / biliary complications • To test a relationship between arterial reconstructions on back table and early and late graft survival after LT, both in adult and in pediatric recipients
PATIENTS AND METHODS • We reviewed our series of LT and we recorded: • Arterial variants in donors, and reconstructions performed on back table • Then, according to arterial reconstructions, and separately considering pediatric and adult recipients, we reviewed: • grafts that underwent hepatic artery thrombosis • grafts that underwent major - requiring open surgery - biliary complications (excluding partial grafts) • graft survival (in Whole grafts, excluding Retransplantations)
RHA: right hepatic artery; LHA: left hepatic artery; SMA: superior mesenteric artery; CT: celiac trunk
62 grafts with arterial variants underwent arterial reconstructions
RECIPIENTS WITH RECONSTRUCTIONS 10% 9,2% 9,6% 9,%
Hepatic artery thrombosis 1 vs 2: ns. 2 vs 3: ns 2 vs 4: 0.003 2 vs 5: 0.000 2 vs 6: ns 7 vs 9: ns Wo = Without
Wo = Without W = With WL = Whole Liver 3 vs 4: ns.
Arterial reconstructions and Graft actuarial survival in adults (WG, no retx) Log rank test: ns
Graft actuarial survival in pediatrics (WG, no retx) Log rank test: ns
Conclusions I • The rate of arterial anatomic variants in liver supply is quite high (22%) but only 9% of grafts need an arterial reconstruction • Most frequent arterial variant (80%) needing reconstruction is RHA from SMA. The most frequent reconstruction is RHASA (43%).
Conclusions II • Arterial reconstructions due to hepatic arterial variants don’t undergo statistically significant higher rates of HAT (6%); therefore a more strict arterial surveillance for HAT is not mandatory in grafts with arterial reconstructions. • Aortic conduits have the highest rate of thrombosis (13%) and need surveillance. • The rate of major biliary complications is not influenced by arterial reconstructions. • Graft survival at 1-3-5-10 years after LT is not influenced with statistically significance by arterial reconstructions. firstname.lastname@example.org