title: Aorto-hepatic bypass in liver transplantation in the MELD-era: outcomes after supraceliac and infrarenal bypasses.
abstract: OBJECTIVE
  Poor arterial inflow during orthotopic liver transplantation (OLT) may necessitate arterial revascularisation using aorto-hepatic bypasses with supraceliac (SC) or infrarenal (IR) allografts. This study compared both techniques focusing on the patients' preoperative conditions, postoperative graft/organ function, complications and survival.
  
  
  METHODS
  Fifteen out of 114 OLT patients underwent revascularisation (7 IR/8 SC) between 2005 and 2008 and were included in the study. The patients' records were reviewed retrospectively.
  
  
  RESULTS
  IR patients presented with a higher BMI, received more male donor organs and their reperfusion sequence was predominately portal venous (SC: primary arterial). SC patients presented a significantly worse preoperative creatinine clearance and a trend towards a higher MELD score. The postoperative graft/organ function, morbidity and mortality did not differ between the groups despite a trend towards a worse survival in the SC group. A deteriorated preoperative creatinine clearance and higher MELD score negatively impacted the survival. Postoperative bleeding episodes and major re-interventions also affected the outcome.
  
  
  CONCLUSIONS
  We found no evidence for superiority of either bypass technique in our OLT patients. The trend toward a worse survival in SC patients was most likely caused by the worse preoperative conditions of these patients and highlights the importance of the impact of the MELD score on the outcome after OLT.
authors: Department of General and Visceral Surgery, University of Muenster, Waldeyerstrasse 1, 48149, Muenster, Germany.
authors: Richard
authors: R
authors: Hummel
authors: Sabrina
authors: S
authors: Irmscher
authors: Christina
authors: C
authors: Schleicher
authors: Norbert
authors: N
authors: Senninger
authors: Jens G
authors: JG
authors: Brockmann
authors: Heiner H
authors: HH
authors: Wolters
mesh_terms: D000328:Adult; D001011:Aorta / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D015992:Body Mass Index; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate