The type of arterial anastomosis influences hepatic hemodynamics and overall survival in liver graft recipients.
OBJECTIVE
Evaluation of the influence of arterial anastomoses on hepatic hemodynamics and overall survival in liver graft recipients using color Doppler ultrasound.


METHODS
224 patients recruited retrospectively were divided into five groups according to arterial anastomoses: (1) common hepatic (CHA)/gastro duodenal, (2) CHA/CHA, (3) aorta/celiac trunc, (4) aorta/aorta, (5) more than one anastomosis. We compared maximum portal [(P)Vmax], systolic [(A)Vmax] and end diastolic [(A)Vmin] arterial velocities, resistance indexes(RI), spleen and liver size between the groups. We analyzed further in a multivariate analysis the influence of time elapsed since orthotopic liver transplantation, age of recipient and donor on significant parameters as well as the overall survival of the patients between the groups.


RESULTS
Significant differences were found for: (A) Vmax between groups 2/4 (p<0.007) and 2/5 (p<0.010), (A) Vmin between groups 1/3 (p<0.029) and 2/3 (p<0.015) and RI between the groups 1/3 (p<0.018) and 3/4 (p<0.006). (A)Vmax and RI were only dependent on the type of arterial anastomosis (p<0.008 and p<0.014). The overall survival of the patients between the groups was significantly different (p<0.047).


CONCLUSIONS
In this study we report the natural course of the mean values of portal and arterial velocities in different arterial reconstructions for the first time. (A) Vmax of the hepatic artery is identified as the most promising candidate prognostic parameter for the assessment of hemodynamic alterations after liver transplantation originating in the type of arterial anastomosis performed. The group of patients with more than one anastomosis had the lowest arterial (A) Vmax and simultaneously the lowest overall survival.
Boozari
B
B
Gastroenterology and Hepatology and Endocrinology, Medical School Hannover, Hannover. boozari.bita@mh-hannover.de
Nashan
B
B
Hecker
H
H
Kubicka
S
S
Klempnauer
J
J
Strassburg
C
C
Manns
M
M
Gebel
M J
MJ
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D001012:Aorta, Abdominal / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors