Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, FL 33331, USA.
Liver Transpl. 2013 Aug;19(8):916-25. doi: 10.1002/lt.23689.
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.
肝动脉-肝外主动脉通道为肝移植时移植物动脉化提供了重要的替代方法。关于合并症的发生率存在相互矛盾的结果，并且缺乏原发性移植物的长期生存数据。为了确定原发性肝移植中肝动脉-肝外主动脉通道相关并发症及其对生存的影响，我们对 1998 年至 2009 年期间所有连续进行的成人（n = 1379）和儿科原发性肝移植（n = 188）进行了单中心回顾性队列分析。将肝动脉-肝外主动脉通道的结果与标准动脉再血管化的结果进行比较。与接受标准动脉化的成人（n = 1112）相比，接受通道的成人（n = 267）的迟发性（移植后 1 个月以上）肝动脉血栓形成（HAT；4.1%对 0.7%，P < 0.001）和缺血性胆管炎（7.5%对 2.7%，P < 0.001）发生率更高，5 年移植物存活率更低（61%对 70%，P = 0.01）。通道组移植物丢失的调整后的危险比（HR）为 1.38 [95%置信区间（CI）= 1.03-1.85，P = 0.03]。值得注意的是，使用通道（HR = 4.91，95%CI = 1.92-12.58）和热缺血时间> 60 分钟（HR = 11.12，95%CI = 3.06-40.45）是迟发性 HAT 的独立危险因素。在儿童中，通道组（n = 81）和标准组（n = 107）的并发症谱相似。在儿科队列中，尽管通道组（69%）的 5 年移植物存活率明显低于标准组（81%，P = 0.03），但多变量分析并未显示使用肝动脉-肝外主动脉通道是移植物存活率降低的独立预测因素。总之，在成人原发性肝移植中，由于并发症发生率较高（尤其是迟发性 HAT）和移植物存活率降低，应严格限制使用肝动脉-肝外主动脉通道；对于儿童，其合理使用可能是可以接受的。
