Czigany Zoltan, Boecker Joerg, Morales Santana Daniel Antonio, Bednarsch Jan, Meister Franziska Alexandra, Amygdalos Iakovos, Isfort Peter, Liebl Martin, Neumann Ulf Peter, Lurje Georg
Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Institute of Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany.
J Clin Med. 2019 Apr 23;8(4):550. doi: 10.3390/jcm8040550.
Median arcuate ligament compression (MALC) potentially causes arterial complications in orthotopic liver transplantation (OLT). Here we aimed to investigate the incidence of MALC and its impact on clinical outcome after OLT. In addition, we performed an international survey among 52 European liver transplant centers to explore local protocols on the management of these patients. Data of 286 consecutive OLT recipients from a prospective database were analyzed retrospectively (05/2010-07/2017). Preoperative computed-tomography images were evaluated. Celiac axis stenosis due to MALC was found in 34 patients (12%). Intrinsic stenosis was present in 16 (6%) patients. Twenty-six patients (77%) with MALC underwent standard arterial revascularization with median arcuate ligament (MAL)-division. Patients treated for MALC had comparable baseline data and no difference was found in early- and long-term outcome compared to the rest of our cohort. Our survey found heterogeneous strategies regarding diagnosis and treatment of MALC. Only 29% of the centers reported the division of MAL in these patients as routine procedure. Even though there is no consensus on diagnosis and management of MALC among European centers, a surgical division of MAL is feasible and safe and should be considered in OLT recipients with MALC.
正中弓状韧带压迫（MALC）可能会在原位肝移植（OLT）中引发动脉并发症。在此，我们旨在调查MALC的发生率及其对OLT术后临床结局的影响。此外，我们对52个欧洲肝移植中心进行了一项国际调查，以探索这些患者管理的当地方案。对来自前瞻性数据库的286例连续OLT受者的数据进行回顾性分析（2010年5月至2017年7月）。评估术前计算机断层扫描图像。34例患者（12%）发现因MALC导致的腹腔干狭窄。16例（6%）患者存在固有狭窄。26例（77%）患有MALC的患者接受了正中弓状韧带（MAL）切开的标准动脉血运重建术。接受MALC治疗的患者基线数据具有可比性，与我们队列的其他患者相比，早期和长期结局无差异。我们的调查发现，关于MALC的诊断和治疗存在不同的策略。只有29%的中心报告将这些患者的MAL切开作为常规程序。尽管欧洲各中心在MALC的诊断和管理上尚未达成共识，但MAL的手术切开是可行且安全的，对于患有MALC的OLT受者应予以考虑。
