The authors of this article have no conflicts of interest to disclose.
Long-term deleterious effects of aortohepatic conduits in primary liver transplantation: Proceed with caution
Article first published online: 29 JUL 2013
© 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 8, pages 916–925, August 2013
How to Cite
Hibi, T., Nishida, S., Levi, D. M., Sugiyama, D., Fukazawa, K., Tekin, A., Fan, J., Selvaggi, G., Ruiz, P. and Tzakis, A. G. (2013), Long-term deleterious effects of aortohepatic conduits in primary liver transplantation: Proceed with caution. Liver Transpl, 19: 916–925. doi: 10.1002/lt.23689
- Issue published online: 29 JUL 2013
- Article first published online: 29 JUL 2013
- Accepted manuscript online: 19 JUN 2013 02:51AM EST
- Manuscript Accepted: 19 MAY 2013
- Manuscript Received: 1 JAN 2013
Aortohepatic conduits provide a vital alternative for graft arterialization during liver transplantation. Conflicting results exist with respect to the rates of comorbidities, and long-term survival data on primary grafts are lacking. To identify the complications associated with aortohepatic conduits in primary liver transplantation and their impact on survival, we conducted a single-center, retrospective cohort analysis of all consecutive adult (n = 1379) and pediatric primary liver transplants (n = 188) from 1998 to 2009. The outcomes of aortohepatic conduits were compared to those of standard arterial revascularization. Adults with a conduit (n = 267) demonstrated, in comparison with adults with standard arterialization (n = 1112), an increased incidence of late (>1 month after transplantation) hepatic artery thrombosis (HAT; 4.1% versus 0.7%, P < 0.001) and ischemic cholangiopathy (7.5% versus 2.7%, P < 0.001) and a lower 5-year graft survival rate (61% versus 70%, P = 0.01). The adjusted hazard ratio (HR) for graft loss in the conduit group was 1.38 [95% confidence interval (CI) = 1.03-1.85, P = 0.03]. Notably, the use of conduits (HR = 4.91, 95% CI = 1.92-12.58) and a warm ischemia time > 60 minutes (HR = 11.12, 95% CI = 3.06-40.45) were independent risk factors for late HAT. Among children, the complication profiles were similar for the conduit group (n = 81) and the standard group (n = 107). In the pediatric cohort, although the 5-year graft survival rate for the conduit group (69%) was significantly impaired in comparison with the rate for the standard group (81%, P = 0.03), the use of aortohepatic conduits did not emerge as an independent predictor of diminished graft survival via a multivariate analysis. In conclusion, in adult primary liver transplantation, the placement of an aortohepatic conduit should be strictly limited because of the greater complication rates (notably late HAT) and impaired graft survival; for children, its judicious use may be acceptable. Liver Transpl 19:916–925, 2013. © 2013 AASLD.