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Aorto-hepatic bypass in liver transplantation in the MELD-era: outcomes after supraceliac and infrarenal bypasses

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Abstract

Purpose

Poor arterial inflow during orthotopic liver transplantation (OLT) may necessitate arterial revascularisation using aorto-hepatic bypasses with supraceliac (SC) or infrarenal (IR) allografts. This study compared both techniques focusing on the patients’ preoperative conditions, postoperative graft/organ function, complications and survival.

Methods

Fifteen out of 114 OLT patients underwent revascularisation (7 IR/8 SC) between 2005 and 2008 and were included in the study. The patients’ records were reviewed retrospectively.

Results

IR patients presented with a higher BMI, received more male donor organs and their reperfusion sequence was predominately portal venous (SC: primary arterial). SC patients presented a significantly worse preoperative creatinine clearance and a trend towards a higher MELD score. The postoperative graft/organ function, morbidity and mortality did not differ between the groups despite a trend towards a worse survival in the SC group. A deteriorated preoperative creatinine clearance and higher MELD score negatively impacted the survival. Postoperative bleeding episodes and major re-interventions also affected the outcome.

Conclusions

We found no evidence for superiority of either bypass technique in our OLT patients. The trend toward a worse survival in SC patients was most likely caused by the worse preoperative conditions of these patients and highlights the importance of the impact of the MELD score on the outcome after OLT.

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Conflict of interest

There is no conflict of interest for either of the authors/co-authors to declare. In addition, the authors state that they have full control of all primary data, and that they agree to allow the journal to review their data if requested.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, University of Muenster, Waldeyerstrasse 1, 48149, Muenster, Germany

    Richard Hummel, Sabrina Irmscher, Christina Schleicher, Norbert Senninger & Heiner H. Wolters

  2. Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK

    Jens G. Brockmann

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  1. Richard Hummel
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  2. Sabrina Irmscher
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  3. Christina Schleicher
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  4. Norbert Senninger
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Correspondence to Heiner H. Wolters.

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Hummel, R., Irmscher, S., Schleicher, C. et al. Aorto-hepatic bypass in liver transplantation in the MELD-era: outcomes after supraceliac and infrarenal bypasses. Surg Today 44, 626–632 (2014). https://doi.org/10.1007/s00595-013-0513-9

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  • DOI: https://doi.org/10.1007/s00595-013-0513-9

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