Jeune Florence, Lim Chetana, Savier Éric, Goumard Claire, Perdigao Fabiano, Rousseau Géraldine, Scatton Olivier
Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
Sorbonne Université, Paris, France.
Clin Transplant. 2025 Sep;39(9):e70323. doi: 10.1111/ctr.70323.
Hepatic artery (HA) injury during liver procurement is a significant concern in liver transplantation (LT). This study assessed its frequency and impact in deceased donor LT (DDLT).
This was a single-center cohort study of adults who underwent DDLT from 2010 to 2019. HA injury was defined as the section or ligation of arterial branches supplying the graft. Recipients, donors' characteristics and outcomes of LTs using grafts with HA injury (group 1, n = 35) were compared to LTs using grafts without HA injury (group 2, n = 677). A propensity score matching (PSM) was applied. The primary endpoint was 90-day hepatic artery thrombosis (HAT); secondary endpoints included major biliary complications, retransplantation, patient, and graft-survival.
HA injury occurred in 4.9% of grafts. Aberrant HA anatomy was an independent predictive factor of HA injury (OR = 8.1 [3.7-17.9], p < 0.0001). Arterial reconstruction was required in 53.8% of injured grafts, while 23% had lateral sutures and 23% required no reconstruction. Arterial ischemia time was longer in group 1 (50 min [42-67] vs. 43 min [35-56]; p = 0.007). At 90-day, HAT (2.9% vs. 0.7%; p = 0.26), major biliary complications (5.7% vs. 7.2%, p>0.99) and retransplantation rates (2.9 % vs. 1%, p = 0.33) were similar. After PSM, theses outcomes remained comparable. The 5-year patient (74.3% vs. 78.3 %, p = 0.77) and graft-survival (70.2% vs. 75.6%, p = 0.78) were also similar.
HA injury during procurement was rare and did not impact mid- or long-term LT outcomes, supporting a "non-restrictive graft policy" regarding grafts with HA injury.
肝移植（LT）中肝脏获取过程中的肝动脉（HA）损伤是一个重大问题。本研究评估了其在尸体供肝肝移植（DDLT）中的发生率及影响。
这是一项对2010年至2019年接受DDLT的成人进行的单中心队列研究。HA损伤定义为供应移植物的动脉分支的切断或结扎。将使用有HA损伤移植物的肝移植受者、供者特征及结果（第1组，n = 35）与使用无HA损伤移植物的肝移植（第2组，n = 677）进行比较。应用倾向评分匹配（PSM）。主要终点为90天肝动脉血栓形成（HAT）；次要终点包括主要胆道并发症、再次移植、患者及移植物存活情况。
4.9%的移植物发生HA损伤。异常的HA解剖结构是HA损伤的独立预测因素（OR = 8.1 [3.7 - 17.9]，p < 0.0001）。53.8%的损伤移植物需要进行动脉重建，23%进行侧方缝合，23%无需重建。第1组的动脉缺血时间更长（50分钟[42 - 67]对43分钟[35 - 56]；p = 0.007）。90天时，HAT（2.9%对0.7%；p = 0.26）、主要胆道并发症（5.7%对7.2%，p > 0.99）及再次移植率（2.9%对1%，p = 0.33）相似。PSM后，这些结果仍然相当。5年患者生存率（74.3%对78.3%，p = 0.77）及移植物生存率（70.2%对75.6%，p = 0.78）也相似。
获取过程中的HA损伤罕见，且不影响肝移植的中长期结果，支持对有HA损伤的移植物采取“非限制性移植物政策”。
