Ischemic arterial complications after liver transplantation in the adult: multivariate analysis of risk factors.
OBJECTIVE
To minimize the incidence of ischemic arterial complications, risk factors should be clearly identified. Knowledge of the predisposing factors for such complications would make possible the institution of strict surveillance protocols that could ensure early detection of complications and so prevent the progression of ischemic damage to graft failure.


METHODS
Retrospective univariate and multivariate analysis.


METHODS
University hospital.


METHODS
Six hundred fifty-three adults who underwent 747 orthotopic liver transplantations.


METHODS
We used univariate and multivariate analyses to retrospectively assess the role of possible risk factors for early and late HA thrombosis (HAT) and stenosis (HAS), including etiology of liver disease, donor and recipient sex and age (aged < or =60 vs >60 years), cause of donor death, preservation solution, cold ischemic time, previous orthotopic liver transplantation, HA back-table reconstruction, direct arterial anastomosis vs interpositional conduit, experience of the surgeon, intraoperative transfusion requirements, acute rejection, and cytomegalovirus infection.


RESULTS
We observed 58 ischemic complications, including 26 early HAT, 13 late HAT, and 19 HAS. Independent predictors of early HAT were donor age greater than 60 years and bench reconstruction of anatomical variants of the HA; of late HAT, arterial anastomosis fashioned using an interpositional graft of donor iliac artery (iliac conduit) and donors who died of cerebrovascular accident; and of HAS, previous orthotopic liver transplantation and cytomegalovirus infection.


CONCLUSIONS
Predisposing factors for HAT mostly stem from donor and graft features. Use of iliac conduits should be limited, particularly when using old donors. Frequent screening of the arterial flow to the graft with Doppler ultrasonography is advisable in patients at risk.
Vivarelli
Marco
M
Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, 940138 Bologna, Italy. vivarelli@orsola-malpighi.med.unibo.it
Cucchetti
Alessandro
A
La Barba
Giuliano
G
Bellusci
Roberto
R
De Vivo
Antonio
A
Nardo
Bruno
B
Cavallari
Antonino
A
Pinna
Antonio D
AD
D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology*; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*