Bhatti Abu Bakar H, Khan Siddique, Farooq Mohammad H, Ishtiaq Wasib, Khan Nusrat Y
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan; Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Surgery. 2023 Nov;174(5):1263-1269. doi: 10.1016/j.surg.2023.08.012. Epub 2023 Sep 13.
The outcomes of liver transplantation with hepatic arterial reconstruction using interposition saphenous vein conduits are not widely reported. Here, we share our experience using great saphenous vein conduits for hepatic arterial reconstruction in living donor liver transplantation.
This was a single-center retrospective review of patients who underwent living donor liver transplantation (n = 950). The saphenous vein conduits were used in 39 patients. We compared hepatic artery thrombosis, graft dysfunction, and 30-day and 1-year survival in the early (2012-2017) and late (2017-2020) transplant periods.
Among 39 patients (of whom 30 [76.9%] were males, median Model for End-Stage Liver Disease was 24 [interquartile range, 17-27], median age was 50 [interquartile range, 43-54]), saphenous vein conduits were placed on supra celiac aorta in 7 (17.9%), infrarenal aorta in 25 (64.1%), and other arteries in 7 (17.9%) patients. The number of biliary and hepatic vein anastomoses, total arterial ischemia time, portal vein-hepatic artery reperfusion time, and duration of surgery was different in the 2 groups (P < .05). The 30-day mortality was 5/21 (23.8%) and 0 in the early and late periods (P = .05). The 30-day survival was >90% in patients with portal vein-hepatic artery reperfusion time <240 minutes, ≤2 grade 3 complications, no graft dysfunction, and later period of transplantation (P < .05). The 1-year survival with standard transplantation, transplantation with saphenous vein conduits in the early and late period was 87%, 62%, and 89% (P = .022).
Liver transplantation with saphenous vein conduits is associated with acceptable outcomes. Major complications and arterial ischemia times are major determinants of outcomes.
使用大隐静脉移植管进行肝动脉重建的肝移植结果尚未得到广泛报道。在此，我们分享我们在活体肝移植中使用大隐静脉移植管进行肝动脉重建的经验。
这是一项对接受活体肝移植患者（n = 950）的单中心回顾性研究。39例患者使用了大隐静脉移植管。我们比较了早期（2012 - 2017年）和晚期（2017 - 2020年）移植期的肝动脉血栓形成、移植物功能障碍以及30天和1年生存率。
39例患者中（其中30例[76.9%]为男性，终末期肝病模型中位数为24[四分位间距，17 - 27]，年龄中位数为50[四分位间距，43 - 54]），7例（17.9%）患者的大隐静脉移植管置于腹腔干上方的腹主动脉，25例（64.1%）置于肾下腹主动脉，7例（17.9%）置于其他动脉。两组的胆管和肝静脉吻合数量、总动脉缺血时间、门静脉 - 肝动脉再灌注时间以及手术持续时间不同（P < 0.05）。早期和晚期的30天死亡率分别为5/21（23.8%）和0（P = 0.05）。门静脉 - 肝动脉再灌注时间<240分钟、≤2级3类并发症、无移植物功能障碍且为晚期移植的患者30天生存率>90%（P < 0.05）。标准移植、早期和晚期使用大隐静脉移植管移植的1年生存率分别为87%、62%和89%（P = 0.022）。
使用大隐静脉移植管进行肝移植的结果是可以接受的。主要并发症和动脉缺血时间是结果的主要决定因素。
