BACKTABLE ARTERIAL RECONSTRUCTION IN LIVER TRANSPLANTATION: SINGLE CENTRE EXPERIENCE

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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
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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

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PATIENTS AND METHODS
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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)

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RESULTS
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RHA right hepatic artery LHA left hepatic
artery SMA superior mesenteric artery CT
celiac trunk
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62 grafts with arterial variants underwent
arterial reconstructions
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RECIPIENTS WITH RECONSTRUCTIONS
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9,6
9,
9,2
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Arterial reconstructions in 62 grafts
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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
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Wo Without W With WL Whole Liver
3 vs 4 ns.
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Arterial reconstructions and Graft actuarial
survival in adults (WG, no retx)
Log rank test ns
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Graft actuarial survival in pediatrics (WG, no
retx)
Log rank test ns
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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 RHA?SA (43).

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Conclusions II

• Arterial reconstructions due to hepatic
  arterial variants dont 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.

u.maggi_at_tiscali.it