Hepatic allograft arterialization by means of the gastroduodenal bifurcation (branch patch) as a prognostic factor.
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.
Meneu-Diaz
J C
JC
Department of General, Digestive and Abdominal Organs Transplantation, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
Moreno-Gonzalez
E
E
Garcia Garcia
I
I
Jimenez Romero
C
C
Loinaz Segurola
C
C
Gomez Sanz
R
R
Proposito
D
D
Elola-Olaso
A Moreno
AM
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