title: Hepatic allograft arterialization by means of the gastroduodenal bifurcation (branch patch) as a prognostic factor.
abstract: BACKGROUND
  Because of the current shortage of cadaveric organs, it is important to determine preoperatively those variables that are readily available, inexpensive, and noninvasive that can predict a higher incidence of hepatic artery thrombosis (HAT).
  
  
  METHODS
  From April 1986 to October 2001, 717 patients underwent 804 liver transplants. All the arterial reconstructions were performed with fine (7-0) monofilament sutures in an interrupted fashion. Two methods were used: group I, end-to-end arterial anastomosis, and group II, the gastroduodenal branch patch.
  
  
  RESULTS
  After a mean follow-up of 72 (range 3-174) months, HAT was observed in 19 patients (overall incidence 2.4%). End-to-end anastomosis (group I) was performed in 39.50% (316) of cases, and HAT developed in 14 (4.4%) cases. Branch-patch anastomoses (group II) were carried out in 60.5% (488) of the patients; the presence of HAT was detected in five cases (1.03%) (P = 0.03, P < 0.05). A total of 21 variables were selected in the univariate analysis; however, after the multivariate analysis, all but two of the factors lost statistical significance, and these corresponded to the type of arterial reconstruction (gastroduodenal branch patch vs. end-to-end) and the ABO compatibility.
  
  
  CONCLUSIONS
  Liver transplantation with compatible grafts using branch-patch anastomosis for the arterialization (both manipulative by the transplant team) reduces HAT-derived loss of grafts, with the consequent increase in graft availability and reduced mortality rate on the waiting list.
authors.affiliation: Department of General, Digestive and Abdominal Organs Transplantation, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Meneu-Diaz
authors.forename: E
authors.initials: E
authors.lastname: Moreno-Gonzalez
authors.forename: I
authors.initials: I
authors.lastname: Garcia Garcia
authors.forename: C
authors.initials: C
authors.lastname: Jimenez Romero
authors.forename: C
authors.initials: C
authors.lastname: Loinaz Segurola
authors.forename: R
authors.initials: R
authors.lastname: Gomez Sanz
authors.forename: D
authors.initials: D
authors.lastname: Proposito
authors.forename: A Moreno
authors.initials: AM
authors.lastname: Elola-Olaso
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001158:Arteries; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014184:Transplantation, Homologous