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Saphenous vein conduits for hepatic arterial reconstruction in living donor liver transplantation

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Abstract

Purpose

Occasionally, a recipient’s native hepatic arteries are not suitable for reconstruction in living donor liver transplantation (LDLT). The use of the great saphenous vein (GSV) conduits in such patients is seldom practiced since arterial conduits from deceased donors are available. Here, we share our experience with a significantly large group of LDLT recipients who underwent arterial reconstruction with GSV conduits.

Methods

We reviewed patients who underwent LDLT between 2012 and 2017. Patients who had arterial reconstruction using native hepatic arteries (group 1)(n = 452) were compared with those who had GSV interposition conduits for reconstruction (group 2)(n = 21). We compared hepatic artery thrombosis (HAT) rate, allograft dysfunction, morbidity, mortality, and actuarial 5-year survival in the two groups.

Results

HAT was seen in 0/452 (0%) versus 1/21(4.7%) patients (P = 0.04). Allograft dysfunction was seen in 89/423 (21%) versus 6/19(31.5%) (P = 0.2) patients. Overall mortality was 81/452 (17.9%) versus 8/21(38%) (P = 0.02). Death after a biliary complication was seen in 24/452 (5.3%) versus 4/21 (19%) patients (P = 0.02). Actuarial 1- and 5-year overall survival was 85% versus 67% and 79% versus 58% (P = 0.008).

Conclusion

GSV conduits are a suboptimal alternative for establishing hepatic arterial inflow in LDLT, but remain valuable in ominous situations.

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Authors and Affiliations

  1. Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Sector H-8/4 Pitras Bukhari Road, Islamabad, Pakistan

    Abu Bakar Hafeez Bhatti, Faisal Saud Dar, Ammal Imran Qureshi & Siraj Haider

  2. Department of Anesthesiology, Shifa International Hospital, Sector H-8/4 Pitras Bukhari Road, Islamabad, Pakistan

    Nasir Ayub Khan

Authors
  1. Abu Bakar Hafeez Bhatti
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  2. Faisal Saud Dar
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  3. Ammal Imran Qureshi
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  4. Siraj Haider
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  5. Nasir Ayub Khan
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Contributions

Abu Bakar Hafeez Bhatti contributed to study conception and design, acquisition of data, analysis and interpretation of data, rafting of manuscript, and critical revision of manuscript. Faisal Saud Dar contributed to study conception and design, drafting of manuscript, and critical revision of manuscript. Ammal Imran Qureshi contributed to study conception and design, acquisition of data, drafting of manuscript, and critical revision of manuscript. Siraj Haider contributed to acquisition of data, analysis and interpretation of data, and critical revision of manuscript. M Nasir Ayub Khan contributed to study conception and design, drafting of manuscript, and critical revision of manuscript.

Corresponding author

Correspondence to Abu Bakar Hafeez Bhatti.

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The authors declare that they have no conflict of interest.

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The hospital ethics committee approved the study and informed consent was taken from all participants.

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Bhatti, A.B.H., Dar, F.S., Qureshi, A.I. et al. Saphenous vein conduits for hepatic arterial reconstruction in living donor liver transplantation. Langenbecks Arch Surg 404, 293–300 (2019). https://doi.org/10.1007/s00423-019-01774-1

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  • DOI: https://doi.org/10.1007/s00423-019-01774-1

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