title: Ischemic arterial complications after liver transplantation in the adult: multivariate analysis of risk factors.
abstract: 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.
authors.affiliation: Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, 940138 Bologna, Italy. vivarelli@orsola-malpighi.med.unibo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Giuliano
authors.initials: G
authors.lastname: La Barba
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellusci
authors.forename: Antonio
authors.initials: A
authors.lastname: De Vivo
authors.forename: Bruno
authors.initials: B
authors.lastname: Nardo
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallari
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: 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*