title: Long-term deleterious effects of aortohepatic conduits in primary liver transplantation: proceed with caution.
abstract: Aortohepatic conduits provide a vital alternative for graft arterialization during liver transplantation. Conflicting results exist with respect to the rates of comorbidities, and long-term survival data on primary grafts are lacking. To identify the complications associated with aortohepatic conduits in primary liver transplantation and their impact on survival, we conducted a single-center, retrospective cohort analysis of all consecutive adult (n = 1379) and pediatric primary liver transplants (n = 188) from 1998 to 2009. The outcomes of aortohepatic conduits were compared to those of standard arterial revascularization. Adults with a conduit (n = 267) demonstrated, in comparison with adults with standard arterialization (n = 1112), an increased incidence of late (>1 month after transplantation) hepatic artery thrombosis (HAT; 4.1% versus 0.7%, P < 0.001) and ischemic cholangiopathy (7.5% versus 2.7%, P < 0.001) and a lower 5-year graft survival rate (61% versus 70%, P = 0.01). The adjusted hazard ratio (HR) for graft loss in the conduit group was 1.38 [95% confidence interval (CI) = 1.03-1.85, P = 0.03]. Notably, the use of conduits (HR = 4.91, 95% CI = 1.92-12.58) and a warm ischemia time > 60 minutes (HR = 11.12, 95% CI = 3.06-40.45) were independent risk factors for late HAT. Among children, the complication profiles were similar for the conduit group (n = 81) and the standard group (n = 107). In the pediatric cohort, although the 5-year graft survival rate for the conduit group (69%) was significantly impaired in comparison with the rate for the standard group (81%, P = 0.03), the use of aortohepatic conduits did not emerge as an independent predictor of diminished graft survival via a multivariate analysis. In conclusion, in adult primary liver transplantation, the placement of an aortohepatic conduit should be strictly limited because of the greater complication rates (notably late HAT) and impaired graft survival; for children, its judicious use may be acceptable.
authors.affiliation: Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, FL 33331, USA.
authors.forename: Taizo
authors.initials: T
authors.lastname: Hibi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugiyama
authors.forename: Kyota
authors.initials: K
authors.lastname: Fukazawa
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.forename: Ji
authors.initials: J
authors.lastname: Fan
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D007223:Infant; D007511:Ischemia / Q000473:pathology; D017093:Liver Failure / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis; D016896:Treatment Outcome; D055815:Young Adult