title: Vascular complications in living donor liver transplantation at a high-volume center: Evolving protocols and trends observed over 10 years.
abstract: Vascular complications continue to have a devastating effect on liver transplantation recipients, even though their nature, incidence, and outcome might have actually changed with increasing experience and proficiency in high-volume centers. The aim of this study was to analyze the trends observed in vascular complications with changing protocols in adult and pediatric living donor liver transplantation over 10 years in 2 time frames in terms of nature, incidence, and outcome. It is a retrospective analysis of 391 (group 1, January 2006 to December 2010) and 741 (group 2, January 2011 to October 2013) patients. With a minimum follow-up of 2 years, incidence of hepatic artery thrombosis (HAT) in adults has reduced significantly from 2.2% in group 1 to 0.5% in group 2 (P = 0.02). In group 2, nonsignificantly, more adult patients (75% with HAT) could be salvaged compared with only 25% patients in group 1 (P = 0.12). However, HAT in children had 100% mortality. Incidence of portal vein thrombosis (PVT) in complicated transplants in 2 eras remained the same (P = 0.2) and so has its mortality. The thrombosis rate of the neo-middle hepatic vein was significantly reduced in group 2 (P = 0.01). The incidence of HAT, particularly in adults, has decreased significantly though PVT has continued to puzzle surgeons in complicated transplants. In high-volume centers, increasing proficiency, technical modifications, early diagnosis, and multimodality of treatment is the key to decrease overall morbidity and mortality due to vascular complications. Liver Transplantation 23 457-464 2017 AASLD.
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Center for Liver and Biliary Science, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Shiraz Ahmad
authors.initials: SA
authors.lastname: Rather
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Center for Liver and Biliary Science, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Nayeem
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Center for Liver and Biliary Science, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Shaleen
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Center for Liver and Biliary Science, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Neerav
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Center for Liver and Biliary Science, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Subash
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000473:pathology; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D066027:Transplant Recipients; D016896:Treatment Outcome