title: The role of arterial conduits for revascularisation in adult orthotopic liver transplantation.
abstract: The successful outcome in orthotopic liver transplantation (OLT) is critically dependent on the uncompromised hepatic graft blood inflow. Arterial conduits represent a good solution in cases where conventional revascularisation is not possible. The purpose of this systematic review is to analyse the published evidence on the use of arterial conduits in adult OLT. After review of the Pubmed and EMBASE databases, 19 relevant studies were identified and analysed. Even though patient survival was comparable, most large studies reported worse 1-, 3- and 5-year graft survival rates compared to grafts with standard arterial revascularisation. Primary grafts were more commonly affected than re-grafts. Early and late hepatic artery thrombosis occurred more commonly, while the use of an arterial conduit was identified as an independent risk factor. The overall biliary complications were comparable, however, ischaemic cholangiopathy was encountered about 3 times more in patients with arterial conduits and strongly correlated with the occurrence of late HAT. In conclusion, the use of arterial conduit is a useful option in adult OLT in cases that the conventional revascularisation technique cannot be used or results in suboptimal arterial inflow. More studies directly addressing issues such as pre-operative evaluation regarding the need for arterial conduit, the types of vessels used, positioning of the conduit and post-operative management are required.
authors.affiliation: Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge, UK. Electronic address: chatzizacharias@gmail.com.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Chatzizacharias
authors.affiliation: Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Aly
authors.affiliation: Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Praseedom
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D018570:Risk Assessment; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000379:methods