title: Outcome of hepatic artery reconstruction in liver transplantation with an iliac arterial interposition graft.
abstract: BACKGROUND
  In case of anomal hepatic arterial inflow, it can be necessary to perform revascularization of the liver allograft by iliac arterial interposition graft.
  
  
  METHODS
  We analyzed retrospectively 613 liver transplants in a 16-yr period. The hepatic artery (HA) graft group (n = 101) consisted of patients with arterial inflow based on recipient infrarenal aorta using donor iliac artery graft tunneled through the transverse mesocolon. The control group (n = 512) consisted of patients who underwent liver transplantation with routine HA reconstruction.
  
  
  RESULTS
  Both groups are homogeneous and comparable. In case of retransplantation, arterial conduit with iliac graft was adopted more frequently instead of conventional arterial anastomosis (24.8% vs. 9%, p < 0.0001). The 1-, 3- and 5-yr overall survival was 85.41, 79.42, 76.57% in the control group and 76.21, 73.43, 73.43% in the HA graft group, respectively (p = ns). The 1-, 3- and 5-yr graft survival was better in the control group (81.51, 73.66, 69.22% vs. 71.17, 62.50, 53.42%) (p = 0.01). In case of retransplantation, the 1-, 3- and 5-yr overall (57.81, 53.95, 41.96% vs. 60, 51.95, 49.85%) and graft survival (57.52, 53.68, 41.75% vs. 56, 50.4, 40.3%) was similar in control and HA graft group, respectively (p = ns). Hepatic artery thrombosis (HAT) rate is 21.8% vs. 8.6% (p < 0.0001) in HA graft group and control group, respectively. The only factor independently predictive of early HAT resulted arterial conduit (p = 0.001, OR = 3.13, 95% CI: 1.57-6.21). Retransplant procedure, donor age and arterial iliac conduit were found to be a significant risk factors for late HAT, at univariate analysis. At multivariate analysis, donor age >50 yr old resulted the only factor independently associated with late HAT (p < 0.0001, OR = 1.05, 95% CI: 1.02-1.07).
  
  
  CONCLUSIONS
  Iliac arterial interpositional graft is an alternative solution for arterial revascularization of liver allograft in case of retransplantation when the use of HA is not possible. In case of primary transplantation, is better not to perform arterial conduit if it is possible, for poor graft survival and high incidence of early HAT, especially in case of liver donor aged over 50 yr.
authors.affiliation: Liver and Multiorgan Transplantation Unit, University of Bologna, S.Orsola-Malpighi Hospital, Italy. maxdg974@tiscali.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Varotti
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vetrone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000328:Adult; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000637:transplantation*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*