BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to t...BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.展开更多
AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD ...AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ use.METHODS The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.RESULTS DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI < 1), standard(DCD-RI 2-4) and high risk(DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.CONCLUSION The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001).展开更多
Satisfactory blood flow after hepatic arterial anastomosis in liver transplantation is a critical point of the operation.Problems with this anastomosis can result in hepatic artery thrombosis with resultant graft fail...Satisfactory blood flow after hepatic arterial anastomosis in liver transplantation is a critical point of the operation.Problems with this anastomosis can result in hepatic artery thrombosis with resultant graft failure and patient morbidity and mortality.Causes of hepatic artery thrombosis include problematic technique,hepatic artery dissection,external compression(e.g.from hematoma),hypercoagulable state,splenic arterial steal and rarer causes such as median arcuate ligament compression(MALC).A careful review of preoperative radiology and imaging will reveal these rare instances and enable a proper intraoperative plan.展开更多
文摘BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.
文摘AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ use.METHODS The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.RESULTS DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI < 1), standard(DCD-RI 2-4) and high risk(DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.CONCLUSION The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001).
文摘Satisfactory blood flow after hepatic arterial anastomosis in liver transplantation is a critical point of the operation.Problems with this anastomosis can result in hepatic artery thrombosis with resultant graft failure and patient morbidity and mortality.Causes of hepatic artery thrombosis include problematic technique,hepatic artery dissection,external compression(e.g.from hematoma),hypercoagulable state,splenic arterial steal and rarer causes such as median arcuate ligament compression(MALC).A careful review of preoperative radiology and imaging will reveal these rare instances and enable a proper intraoperative plan.
