Chatzizacharias Nikolaos A, Aly Mohamed, Praseedom Raaj K
Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge, UK.
Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge, UK.
Transplant Rev (Orlando). 2017 Apr;31(2):121-126. doi: 10.1016/j.trre.2016.10.008. Epub 2016 Nov 4.
The successful outcome in orthotopic liver transplantation (OLT) is critically dependent on the uncompromised hepatic graft blood inflow. Arterial conduits represent a good solution in cases where conventional revascularisation is not possible. The purpose of this systematic review is to analyse the published evidence on the use of arterial conduits in adult OLT. After review of the Pubmed and EMBASE databases, 19 relevant studies were identified and analysed. Even though patient survival was comparable, most large studies reported worse 1-, 3- and 5-year graft survival rates compared to grafts with standard arterial revascularisation. Primary grafts were more commonly affected than re-grafts. Early and late hepatic artery thrombosis occurred more commonly, while the use of an arterial conduit was identified as an independent risk factor. The overall biliary complications were comparable, however, ischaemic cholangiopathy was encountered about 3 times more in patients with arterial conduits and strongly correlated with the occurrence of late HAT. In conclusion, the use of arterial conduit is a useful option in adult OLT in cases that the conventional revascularisation technique cannot be used or results in suboptimal arterial inflow. More studies directly addressing issues such as pre-operative evaluation regarding the need for arterial conduit, the types of vessels used, positioning of the conduit and post-operative management are required.
原位肝移植（OLT）的成功结局严重依赖于肝脏移植物不受影响的血流灌注。在无法进行传统血管重建的情况下，动脉血管搭桥是一种不错的解决方案。本系统评价的目的是分析已发表的关于成人OLT中使用动脉血管搭桥的证据。在检索PubMed和EMBASE数据库后，确定并分析了19项相关研究。尽管患者生存率相当，但大多数大型研究报告称，与采用标准动脉血管重建的移植物相比，1年、3年和5年的移植物生存率更低。原发性移植物比再次移植的移植物更常受到影响。肝动脉血栓形成在早期和晚期更为常见，而使用动脉血管搭桥被确定为一个独立的危险因素。总体胆系并发症相当，但在使用动脉血管搭桥的患者中，缺血性胆管病的发生率约高3倍，且与晚期肝动脉血栓形成的发生密切相关。总之，在无法使用传统血管重建技术或导致动脉血流不理想的情况下，动脉血管搭桥在成人OLT中是一种有用的选择。需要更多的研究直接解决诸如术前评估是否需要动脉血管搭桥、所用血管类型、血管搭桥的位置以及术后管理等问题。
