Skip to main content

Advertisement

SpringerLink
Log in

Infrarenal versus supraceliac aorto-hepatic arterial revascularisation in adult liver transplantation: multicentre retrospective study

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

When the standard arterial reconstruction is not feasible during liver transplantation (LT), aorto-hepatic arterial reconstruction (AHAR) can be the only solution to save the graft. AHAR can be performed on the infrarenal (IR) or supraceliac (SC) tract of the aorta, but the possible effect on outcome of selecting SC versus IR reconstruction is still unclear. One hundred and twenty consecutive patients who underwent liver transplantation with AHAR in six European centres between January 2003 and December 2018 were retrospectively analysed to ascertain whether the incidence of hepatic artery thrombosis (HAT) was influenced by the type of AHAR (IR-AHAR vs. SC-AHAR). In 56/120 (46.6%) cases, an IR anastomosis was performed, always using an interposition arterial conduit. In the other 64/120 (53.4%) cases, an SC anastomosis was performed; an arterial conduit was used in 45/64 (70.3%) cases. Incidence of early (≤ 30 days) HAT was in 6.2% (4/64) in the SC-AHAR and 10.7% (6/56) IR-AHAR group (p = 0.512) whilst incidence of late HAT was significantly lower in the SC-AHAR group (4.7% (3/64) vs 19.6% (11/56) - p = 0.024). IR-AHAR was the only independent risk factor for HAT (exp[B] = 3.915; 95% CI 1.400–10.951; p = 0.009). When AHAR is necessary at liver transplantation, the use of the supraceliac aorta significantly reduces the incidence of hepatic artery thrombosis and should therefore be recommended whenever possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AHAR:

Aorto-Hepatic Arterial Reconstruction

SC:

Supraceliac

IR:

Infrarenal

HA:

Hepatic Artery

HAT:

Hepatic artery thrombosis

EAD:

Early allograft dysfunction

ERC:

Endoscopic retrograde cholangiography

ISGLS:

International Study Group of Liver Surgery

LHA:

Left hepatic artery

LT:

Liver transplantation

PNF:

Primary graft non-function

References

  1. Jain A, Reyes J, Kashyap R et al (2000) Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg 232(4):490–500

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Todo S, Makowka L, Tzakis AG et al (1987) Hepatic artery in liver transplantation. Transpl Proc 19(1 Pt 3):2406–2411

    CAS  Google Scholar 

  3. Del Gaudio M, Grazi GL, Ercolani G et al (2005) Outcome of hepatic artery reconstruction in liver transplantation with an iliac arterial interposition graft. Clin Transplant 19(3):399–405

    Article  PubMed  Google Scholar 

  4. El-Hinnawi A, Nishida S, Levi D et al (2013) Use of the recipient celiac trunk for hepatic artery reconstruction in orthotopic liver transplantation. Transpl Proc 45(5):1928–1930

    Article  CAS  Google Scholar 

  5. Muiesan P, Rela M, Nodari F et al (1998) Use of infrarenal conduits for arterial revascularization in orthotopic liver transplantation. Liver Transplant Surg Offi Publ Am Assoc Study of Liver Dis Int Liver Transplant Soc 4(3):232–235

    CAS  Google Scholar 

  6. Shaked AA, Takiff H, Busuttil RW (1991) The use of the supraceliac aorta for hepatic arterial revascularization in transplantation of the liver. Surg Gynecol Obstet 173(3):198–202

    CAS  PubMed  Google Scholar 

  7. Pinto S, Reddy SN, Horrow MM, Ortiz J (2014) Splenic artery syndrome after orthotopic liver transplantation: a review. Int J Surg 12(11):1228–1234

    Article  PubMed  Google Scholar 

  8. Chatzizacharias NA, Aly M, Praseedom RK (2016) The role of arterial conduits for revascularisation in adult orthotopic liver transplantation. Transplant Rev 31:121–126

    Article  Google Scholar 

  9. Denecke C, Weiss S, Biebl M et al (2016) An arterial conduit is not a risk factor for survival following orthotopic liver transplantation: an analysis of 20 years of liver transplantation in Innsbruck. Ann Transplant 21:321–328

    Article  CAS  PubMed  Google Scholar 

  10. Lerut JP, Gordon RD, Tzakis AG, Stieber AC, Iwatsuki S, Starzl TE (1988) The hepatic artery in orthotopic liver transplantation. Helv Chir Acta 55(3):367–378

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Olthoff KM, Kulik L, Samstein B et al (2010) Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 16(8):943–949

    Google Scholar 

  12. Demetris A, Adams D, Bellamy C et al (2000) Update of the International Banff Schema for liver allograft rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology 31(3):792–799

    Article  CAS  PubMed  Google Scholar 

  13. Bekker J, Ploem S, de Jong KP (2009) Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 9(4):746–757

    Article  CAS  PubMed  Google Scholar 

  14. Gunsar F, Rolando N, Pastacaldi S et al (2003) Late hepatic artery thrombosis after orthotopic liver transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 9(6):605–611

    Google Scholar 

  15. Pastacaldi S, Teixeira R, Montalto P, Rolles K, Burroughs AK (2001) Hepatic artery thrombosis after orthotopic liver transplantation: a review of nonsurgical causes. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 7(2):75–81

    CAS  Google Scholar 

  16. Stange BJ, Glanemann M, Nuessler NC, Settmacher U, Steinmuller T, Neuhaus P (2003) Hepatic artery thrombosis after adult liver transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 9(6):612–620

    Google Scholar 

  17. Vivarelli M, La Barba G, Cucchetti A et al (2007) Can antiplatelet prophylaxis reduce the incidence of hepatic artery thrombosis after liver transplantation? Liver Transpl 13(5):651–654

    Article  PubMed  Google Scholar 

  18. Mocchegiani F, Vincenzi P, Lanari J et al (2015) Immunological risk factors in biliary strictures after liver transplantation. Ann Transplant 20:218–224

    Article  CAS  PubMed  Google Scholar 

  19. Lee CM, Stewart L, Way LW (2000) Postcholecystectomy abdominal bile collections. Arch Surg 135(5):538–542 (discussion 542-534)

    Article  CAS  PubMed  Google Scholar 

  20. Hanley JA (1989) Receiver operating characteristic (ROC) methodology: the state of the art. Crit Rev Diagn Imaging 29(3):307–335

    CAS  PubMed  Google Scholar 

  21. Mourad MM, Liossis C, Gunson BK et al (2014) Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 20(6):713–723

    Google Scholar 

  22. Llado L, Ramos E, Bravo A et al (2019) Short- and long-term outcomes of arterial reconstruction on recipient splenic artery in adult liver transplantation Single-center prospective study 25 years after first description. Transplant Int Off J Eur Soc Organ Transplant 32(10):1053–1060

    Article  Google Scholar 

  23. Kazemi K, Samidoost P, Deilami HN et al (2017) A new consideration in hepatic artery reconstruction in adult liver transplant: arterial transposition versus extra-anatomic jump grafts. Exp Clin Transplant Off J Middle East Soc Organ Transplant 15(Suppl 1):204–207

    Google Scholar 

  24. Cherqui D, Riff Y, Rotman N, Julien M, Fagniez PL (1994) The recipient splenic artery for arterialization in orthotopic liver transplantation. Am J Surg 167(3):327–330

    Article  CAS  PubMed  Google Scholar 

  25. Nikitin D, Jennings LW, Khan T et al (2008) Twenty years of follow-up of aortohepatic conduits in liver transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 14(10):1486–1490

    Google Scholar 

  26. Oberkofler CE, Reese T, Raptis DA et al (2018) Hepatic artery occlusion in liver transplantation: what counts more, the type of reconstruction or the severity of the recipient's disease? Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 24(6):790–802

    Google Scholar 

  27. Hibi T, Nishida S, Levi DM et al (2013) Long-term deleterious effects of aortohepatic conduits in primary liver transplantation: proceed with caution. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 19(8):916–925

    Google Scholar 

  28. Reese T, Raptis DA, Oberkofler CE et al (2019) A systematic review and meta-analysis of rescue revascularization with arterial conduits in liver transplantation. Am J Transplant 19(2):551–563

    Article  PubMed  Google Scholar 

  29. Wen J, Yuan D, Wang Q et al (2016) A computational simulation of the effect of hybrid treatment for thoracoabdominal aortic aneurysm on the hemodynamics of abdominal aorta. Sci Rep 6:23801

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Chiu JJ, Usami S, Chien S (2009) Vascular endothelial responses to altered shear stress: pathologic implications for atherosclerosis. Ann Med 41(1):19–28

    Article  CAS  PubMed  Google Scholar 

  31. Lei M, Archie JP, Kleinstreuer C (1997) Computational design of a bypass graft that minimizes wall shear stress gradients in the region of the distal anastomosis. J Vasc Surg 25(4):637–646

    Article  CAS  PubMed  Google Scholar 

  32. Staalsen NH, Ulrich M, Winther J, Pedersen EM, How T, Nygaard H (1995) The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo. J Vasc Surg 21(3):460–471

    Article  CAS  PubMed  Google Scholar 

  33. Chiu JJ, Chien S (2011) Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev 91(1):327–387

    Article  Google Scholar 

  34. Hummel R, Irmscher S, Schleicher C, Senninger N, Brockmann JG, Wolters HH (2014) Aorto-hepatic bypass in liver transplantation in the MELD-era: outcomes after supraceliac and infrarenal bypasses. Surg Today 44(4):626–632

    Article  PubMed  Google Scholar 

  35. Livingston D, Lee DD, Croome S, Burcin Taner C, Croome KP (2019) Comparison of supraceliac and infrarenal aortic conduits in liver transplantation: is there a difference in patency and postoperative renal dysfunction? Transplant Direct 5(11):e499

    Article  PubMed  PubMed Central  Google Scholar 

  36. Oberkofler CE, Raptis DA, DiNorcia J, et al. (2020) How to handle arterial conduits in liver transplantation? evidence from the first multicenter risk analysis. Ann Surg

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, A.O.U. “Ospedali Riuniti”, Polytechnic University of Marche, via Conca 71, 60129, Ancona, Italy

    M. Vivarelli, A. Benedetti Cacciaguerra, D. Nicolini, R. Montalti & F. Mocchegiani

  2. Institut de Recherche Expérimentale et Clinique – IREC, Université catholique Louvain Pôle de Chirurgie Expérimentale et Transplantation – UCL, Brussels, Belgium

    J. Lerut, S. Iesari & K. Ackenine

  3. Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, University of Padua, Padua, Italy

    J. Lanari, U. Cillo & G. Zanus

  4. Department of Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy

    G. Conte & M. Colledan

  5. General Surgery and Transplantation Unit, Department of Medicine, University of Udine, Udine, Italy

    R. Pravisani, A. Risaliti & U. Baccarani

  6. Department of Human Structure and Repair, Ghent University Faculty of Medicine, Ghent, Belgium

    J. Lambrechts, X. Rogiers & R. I. Troisi

  7. Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy

    S. Iesari

  8. Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital, Naples, Italy

    R. I. Troisi & R. Montalti

Authors
  1. M. Vivarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Benedetti Cacciaguerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Lerut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Lanari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Conte
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Pravisani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Lambrechts
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Iesari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. K. Ackenine
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D. Nicolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. U. Cillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. G. Zanus
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Colledan
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A. Risaliti
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. U. Baccarani
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. X. Rogiers
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. R. I. Troisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. R. Montalti
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. F. Mocchegiani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ABC and RM conceived and designed the study. RM and ABC analysed the data. GC, SI, AK, JL, and RP collected data. MV and JL wrote the manuscript. DN, SI, FM, JL, GZ, UB, XR, RIT, AR, MC and UC provided data and critically revised the manuscript.

Corresponding author

Correspondence to A. Benedetti Cacciaguerra.

Ethics declarations

Conflict of interest

None of the authors has a conflict to declare.

Research involving human participants and/or animals

The ethical committee of the Regione Marche approved the study and the protocol (number of ethical committee approval 2018–677).

Informed consent

Informed consent for this type of study is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vivarelli, M., Benedetti Cacciaguerra, A., Lerut, J. et al. Infrarenal versus supraceliac aorto-hepatic arterial revascularisation in adult liver transplantation: multicentre retrospective study. Updates Surg 72, 659–669 (2020). https://doi.org/10.1007/s13304-020-00839-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00839-x

Keywords

Search

Navigation