Li B, Wei XZ, Song JL, Lv T, Yang J, Ma YK, Zhao JC, Jiang M, Yang JY, Huang B. Arterial vs venous conduits for hepatic artery bypass in pediatric living donor liver transplantation: A retrospective study. World J Gastroenterol 2026; 32(48): 121888 [DOI: 10.3748/wjg.121888]
Corresponding Author of This Article
Bin Huang, PhD, Chief, Professor, Department of Vascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. xgwkhb@126.com
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Li B, Wei XZ, Song JL, Lv T, Yang J, Ma YK, Zhao JC, Jiang M, Yang JY, Huang B. Arterial vs venous conduits for hepatic artery bypass in pediatric living donor liver transplantation: A retrospective study. World J Gastroenterol 2026; 32(48): 121888 [DOI: 10.3748/wjg.121888]
Bo Li, Yu-Kui Ma, Ji-Chun Zhao, Bin Huang, Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Bo Li, Tao Lv, Jian Yang, Jia-Yin Yang, Laboratory of Liver Transplantation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao-Zhen Wei, Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Jiu-Lin Song, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Tao Lv, Jian Yang, Jia-Yin Yang, Liver Transplant Center, Organ Transplant Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Min Jiang, Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
Author contributions: Li B and Wei XZ collected all clinical data, performed data analysis, and drafted the manuscript as co-first authors; Song JL, Lv T, Yang J, Ma YK, Zhao JC, and Yang JY participated in the study design and contributed to intraoperative data collection from donors and pediatric recipients; Jiang M participated in the study design, data processing, and data analysis; Huang B participated in the design and oversight of the study and critically reviewed and revised the manuscript for important intellectual content; all authors read and approved the final manuscript.
AI contribution statement: AI tools were not used.
Supported by the National Key Research and Development Program of China, No. 2024YFC2418104; and the Natural Science Foundation of Sichuan Province, No. 2024NSFSC1898.
Institutional review board statement: This study was approved by the Institutional Review Boards of West China Hospital of Sichuan University (No. 2023-2274).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Bin Huang, PhD, Chief, Professor, Department of Vascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. xgwkhb@126.com
Received: April 9, 2026 Revised: June 29, 2026 Accepted: October 8, 2026 Published online: December 28, 2026 Processing time: 209 Days and 4 Hours
Abstract
BACKGROUND
Both venous and arterial conduits have been applied for hepatic artery bypass (HAB) in pediatric liver transplantation (LT). However, there were limited comparisons on their efficacy.
AIM
To compare the efficacy of arterial versus venous conduits for HAB in pediatric living donor LT.
METHODS
We retrospectively reviewed children who received living donor LT between January 2015 and July 2023. Eligible children were categorized according to conduit type to either the great saphenous vein (GSV) conduit group or the arterial conduit group. Their perioperative characteristics and outcomes were analyzed and compared.
RESULTS
A total of 67 children were included, with 34 and 33 children in GSV and arterial conduit groups, respectively. Most GSV conduits (28/34) were harvested from living liver donors, many of whom reported various postoperative local complications. All arterial conduits were from donation after circulatory death. There were no significant differences in the perioperative characteristics and postoperative complications between two groups. There were three cases of hepatic artery thrombosis, with two and one in the GSV and arterial conduit groups, respectively. In addition, there were no significant differences in 1-day, 7-day, and 1-year hepatic artery patency rates, 30-day, 1-year, and 3-year graft survival rates, and 30-day, 1-year, and 3-year overall survival rates between the two groups.
CONCLUSION
No statistically significant differences were observed between arterial and GSV conduit groups for HAB in pediatric living donor LT. Both may serve as viable grafts for HAB.
Core Tip: Both venous and arterial conduits have been applied for hepatic artery bypass (HAB) in pediatric living donor liver transplantation. However, comparisons of their efficacy are limited. Here, we showed that no statistically significant differences were observed between arterial and great saphenous vein conduits for HAB in pediatric living donor liver transplantation. Both may serve as viable grafts for HAB.
Citation: Li B, Wei XZ, Song JL, Lv T, Yang J, Ma YK, Zhao JC, Jiang M, Yang JY, Huang B. Arterial vs venous conduits for hepatic artery bypass in pediatric living donor liver transplantation: A retrospective study. World J Gastroenterol 2026; 32(48): 121888
Hepatic artery (HA) reconstruction is an essential step during pediatric living donor liver transplantation (PLDLT), which is a highly challenging technique. The live donor liver is commonly segmented, with small caliber and multiple short stumps arteries, which seriously affects HA reconstruction. Postoperative complications, such as HA thrombosis (HAT), anastomotic stenosis, and aneurysm, may occur, resulting in primary graft nonfunction, graft loss, and recipient death[1-3]. Clinically, strategies, such as vascular grafts (VGs) and HA bypass (HAB), have been attempted to minimize complications and improve the success rate of the surgical procedure[4]. The use of great saphenous vein (GSV) grafts and arterial grafts has been reported in liver transplantation (LT)[5,6]. López Santamaria et al[5] compared the results of 48 pediatric LTs (PLTs) in which revascularization was achieved by a conduit interposed between the receptor aorta and the VG group with those obtained from 56 PLTs performed during the same period (1991-1994) in which end-to-end anastomosis (EEA) of the hepatic arteries or celiac trunk was used (EEA group). In the VG group, the interposed conduits were the cadaveric iliac artery (IA) (n = 37), the living-donor saphenous vein (n = 3), and nonthrombosed conduits from previous transplants (n = 8) (7 iliac arteries and 1 saphenous vein). The rate of arterial thrombosis did not differ between the two groups. The authors concluded that, although EEA of the HA remains the preferred revascularization technique for PLT, revascularization of the liver graft by conduit interposition is safe when EEA is not feasible. However, this conclusion was based on a comparative study of HA revascularization methods (supra-celiac and infra-renal) in children undergoing LT, with only three PLDLT cases. In addition, VGs were mainly cadaveric iliac arteries (44/48), with very few living-donor GSVs (4/48). Additionally, a retrospective study by Bhatti et al[6] reported that GSV grafts for HAB in adult living donor LT was associated with acceptable outcomes. However, limited studies have compared the short- and long-term prognoses between GSV grafts and arterial grafts for HAB in PLDLT. Therefore, in this study, we investigated the prognosis of children after GSV and arterial conduits in PLDLT.
MATERIALS AND METHODS
Study design and participant selections
We performed a retrospective study of PLDLT cases at West China Hospital of Sichuan University, China, between January 2015 and July 2023. This study was approved by the Institutional Review Boards of West China Hospital of Sichuan University (No. 2023-2274). Given its retrospective design and the use of fully de-identified clinical data, the ethics committee formally waived the requirement for written informed consent from all participants. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.
The study participant inclusion criteria were children below 18 years old who underwent PLDLT and HAB with GSV or arterial conduits. The exclusion criteria were children with re-transplantation, multi-organ transplantation, and missing information and who were lost to follow-up. This was a single-center, consecutive retrospective cohort study. All patients who met the predefined inclusion criteria within the study were enrolled, and no eligible patients were intentionally excluded.
Surgery procedures
Preoperative evaluation and PLDLT procedure: The details of PLDLT were described in our previously reported paper[7,8]. In short, preoperatively, comprehensive examinations, including upper abdominal computed tomography angiography (CTA) and bile duct magnetic resonance cholangiopancreatography, were performed. Intraoperatively, once the donor’s liver parenchyma and surrounding ligaments were completely separated and the perfusion device of the donor liver was prepared, the blood vessels and bile ducts were dissected. The donor liver was immediately perfused with 4 °C histidine-tryptophan-ketoglutarate solution through the portal vein to minimize the thermal ischemia. After resecting the diseased liver in the recipient, sequential reconstruction of the donor hepatic vein, portal vein, HA, and biliary tract were performed.
HAB procedure: The HAB depended on the following criteria: (1) Small caliber arteries (diameter less than 2 mm)[2]; (2) Short HA stumps[5]; (3) The presence of multiple HAs in the graft[9]; and (4) HA dissection[5]. Notably, a small number of cases may present with multiple conditions covered by the above criteria. HAB reconstruction included two types: (1) Supra-celiac; and (2) Infra-renal. Bypass VGs were selected according to the accessibility of grafts, specific vascular conditions [such as vascular diameter matching, and the presence of a pathological state (e.g., atherosclerosis or dissection)]. Both GSV and arterial conduits are viable options, with no priority between these two grafts in our center. The details are as follows: When HAB is anticipated or required in PLDLT, we evaluate the two types of VGs according to the aforementioned criteria. The optimal conduit is selected if it can be harvested intraoperatively without delay, achieves proper diameter matching, and is free from inflammatory changes, atherosclerotic plaques, or intimal dissection. If both satisfy the above criteria, the final choice is left to the discretion of the attending surgeon.
Notably, the diameter of the HA is mainly measured by preoperative CTA, preoperative and intraoperative ultrasonography, combined with intraoperative exploration. Additionally, when using GSV grafts for bypass, the graft needs to be reversed to prevent venous valves from obstructing the blood flow.
VG procurement: We procured the abdominal arteries derived from donations after citizen’s death (DCD) as HAB VGs.
GSV procurement: After making a longitudinal incision along the proximal GSV of the living donor or recipient’s thigh, the main trunk of the GSV was protected and the tributaries were sutured with a vascular sliding thread. Once harvested, the GSV was immersed in heparin solution for trimming, and its integrity and patency were checked before use.
Procurement of DCD-derived arteries: Since 2015, our center routinely performed abdominal artery acquisition during DCD organ procurement, including the spleen artery (SpA), gastroduodenal artery (GDA), superior mesenteric artery (SMA), left gastric artery (GLA), gastroepiploic artery (GeA), and IA acquisitions. After procurement, the arterial grafts were placed in a sterile container containing 4 °C histidine-tryptophan-ketoglutarate solution and stored in a 4 °C refrigerator for no more than 2 days. When necessary, the VGs were trimmed for bypass. All arterial conduits used in this study were fresh grafts.
Postoperative management: Postoperatively, the donors were sent back to the general ward, and the recipients were admitted to the intensive care unit. The patients were closely monitored, and blood tests were assessed routinely. In particular, for recipients, postoperative HA flow was monitored by Doppler ultrasound daily during the first postoperative week and every 2 days afterwards. If the blood flow of HA could not be identified, the patients underwent CTA to evaluate the HA. Patients with HAT were treated by embolectomy, HA re-anastomosis, and catheterization thrombolysis immediately. All pediatric patients received unfractionated heparin for antithrombotic therapy during their postoperative intensive care unit stay. After transfer to the general ward, treatment was switched to warfarin, which was continued for 3-6 months following discharge. The dosages were adjusted according to activated partial thromboplastin time and international normalized ratio levels, with target ranges of 70-90 seconds for activated partial thromboplastin time and 1.7-2.0 for international normalized ratio. In addition, immunosuppressive therapy was given with tacrolimus, mycophenolate mofetil, and corticosteroids. The immunosuppressant dosages were adjusted to maintain a safe upper level according to its blood concentration. After discharge, all patients were followed up monthly in the first year and every 3 months through outpatient visits and telephone interviews. Medical records were reviewed for complete blood count results, blood concentrations of immunosuppressive agents, and abdominal Doppler ultrasonography findings. Furthermore, these patients were followed up until January 1, 2024. There were no children lost to follow-up.
Data collections
Patient demographics, cause of LT, cause of HAB, donor graft segments, intra/postoperative variables, short-term outcomes (> III as evaluated by the Clavien-Dindo classification)[10], and long-term outcomes (HA patency, graft survival, and overall survival) were recorded.
Statistical analysis
Eligible children were assigned into either GSV conduit group or arterial conduit group. Categorical variables were presented as n (%) and compared by the χ2 test or Fisher’s exact test. Continuous variables were presented as the mean ± SD or median with interquartile range and compared by the Student’s t-test or Mann-Whitney U test, depending on the normality test results. Survival analysis was conducted using the Kaplan-Meier product-limit method. The significant difference between survival curves was determined using the log-rank test. Multivariate comparisons of survival distributions were performed using Cox proportional hazards models. Specifically, patients who did not experience the primary endpoint by the end of study’s follow-up, and those who died from non-transplant-related causes were treated as right-censored observations. No patients were lost to follow-up. In the primary analysis, no patients were excluded solely because of a short follow-up duration, as HAT occurs predominantly within the first month after LT, and excluding patients with short follow up could introduce selection bias[1,11]. All statistical analyses were performed using SPSS 25.0 (SPSS Inc., Chicago, IL, United States). A two-sided P < 0.05 was considered statistically significant.
Biostatistics statement: The statistical methods used in this study were reviewed by Min Jiang from the Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University.
RESULTS
Patient and donor characteristics
A total of 69 children underwent PLDLTs during the study period. After excluding two children with re-transplantation, 67 children were analyzed, with 34 children and 33 children in the GSV and arterial conduit groups, respectively (Figure 1). The median follow-up duration was 24.6 (0-143.0) months and 15.7 (0-104.0) months in the GSV and arterial conduit groups, respectively. In addition, the median number of transcatheter arterial chemoembolization (TACE) was six (17.6%) and one (3.0%) for the former and the later. The two groups showed no significant differences in the donor and recipient characteristics (Table 1). The reasons for HAB were small caliber arteries (33/67), short stumps (23/67), multiple HAs (10/67), and HA dissection (4/67). In the arterial conduit group, one child had concurrent HA dissection, multiple HAs, and short arterial stumps, while another had both a small-caliber HA and multiple HAs (Table 2). Interposition vascular conduits were placed in the GDA in 7, common HA in 45, proper HA in 10, and GLA in 2 patients. The infrarenal aorta was used for GSV (n = 1) and IA + SpA (n = 2) conduit placement in three patients (Table 2).
Figure 1 Flowchart of the study.
The process of medical record screening is shown, with 34 individuals in the great saphenous vein conduit group and 33 individuals in the arterial conduit group included in the study analysis. GSV: Great saphenous vein.
Table 1 Baseline and preoperative characteristic comparisons between two groups, n (%)/mean (95%CI).
In the arterial conduit group, the arterial conduits included the SpA (11/33), SMA (9/33), GeA (5/33), GLA (2/33), IA (2/33), GDA (2/33), and IA + SpA (2/33). Only the SpA subgroup had one case of HAT (Table 3). Most procurements in the GSV conduit group were from living liver donors (28/34). We also investigated postoperative complications related to GSV donor sites. GSV donor site (GSV procurement limb) wound infection was observed in two patients. Long-standing peripheral edema of the donor limb was observed in six patients. The donor sites of all patients had varying degrees of scars. The median Vancouver Scar Scale (VSS) score[12] was 8 (2-15) (Table 4).
Table 3 Types of donations after citizen’s death-derived arterial grafts in the arterial conduit group, n (%).
As shown in Table 5, perioperative characteristics did not differ between the groups. The incidence of postoperative complications was 18 (52.9%) in the GSV conduit group and 14 (42.4%) in the arterial conduit group, with no significant difference between the groups (P = 0.389). Notably, three HAT cases occurred within 2 days after surgery. Only one child had a history of TACE. In two patients with GSV conduits, thrombosis occurred within the GSV conduit, whereas in the child with an arterial conduit (SpA), thrombosis occurred in the recipient’s HA, which had an intimal dissection. One child underwent thrombectomy for HA reconstruction, one underwent HA catheterization and thrombolysis, and one underwent re-transplantation. Two children died of liver failure, and one child who underwent re-transplantation died of septic shock (Table 6).
Table 5 Perioperative and postoperative outcome comparisons between two groups, n (%)/median (interquartile range).
HA patency, graft survival, and overall survival were not significantly different between the GSV conduit group and the arterial conduit group. The 1-day, 7-day, and 1-year HA patency rates were 94.1%, 94.1%, and 94.1% vs 100.0%, 97.0%, and 97.0%, respectively [hazard ratio (HR) = 0.51, 95%CI: 0.05-5.57, P = 0.567] (Supplementary Figure 1). The 30-day, 1-year, and 3-year graft survival rates were 85.3%, 82.2%, and 75.4% vs 87.9%, 84.8%, and 84.8%, respectively (HR = 0.79, 95%CI: 0.25-2.50, P = 0.689) (Supplementary Figure 2). The 30-day, 1-year, and 3-year overall survival rates were 85.3%, 82.2%, and 82.2% vs 90.9%, 87.9%, and 87.9%, respectively (HR = 0.68, 95%CI: 0.19-2.42, P = 0.549) (Supplementary Figure 3).
The results of univariate and multivariate Cox regression analyses related to overall survival are presented in Supplementary Tables 1 and 2. The HAB procedure was not identified as a risk factor for survival in the univariate and multivariate analysis models.
DISCUSSION
HAB is a standard procedure when there are small caliber arteries, short HA stumps, multiple graft HAs, and HA dissection during HA reconstruction following LT[5,6]. In the current study, we found that small caliber arteries accounted for 50% of the HAB cases. GSV grafts and DCD-derived arterial grafts are often used in HAB following LT[6,13-15], but there have been relatively few reports in PLDLT[5]. Furthermore, there were limited studies to compare the efficacy and complications between these two VGs in PLDLT. The GSV was the only venous graft used in the HAB of PLDLT in this study. To the best of our knowledge, this is the first study to report the GSV grafts used in the HAB of PLDLT to date. Previous studies have reported that DCD-derived arterial grafts, including the IA, SpA, GLA, GDA, and SMA, were commonly used in HAB during LT[5,14,15]. With the promotion of the National DCD Organ Transplantation Regulations[16], our center began to use DCD-derived arterial conduits in 2015. Unlike the commonly used IAs in previous reports, the most commonly used arterial grafts in our center were the SpA, SMA, and GeA, which accounted for approximately three quarters of cases. This might be due to the fact that small caliber arteries accounted for 50% of our cases. This might also explain the reason why we had fewer cases of infra-renal aorto-hepatic conduit bypass.
The GSV has been widely used for vascular bypass grafts for various organs and its clinical performance is well recognized[17-19]. With advancements in organ donation and transplantation, DCD-derived arterial conduits have also been increasingly adopted in clinical practice. These carry several advantages, including no donor complications, more choices from which to select the appropriate artery for arterial conduits, no additional risks of rejection or immunosuppression for the recipients, and wider availability of VGs because of their prolonged preservation (> 2 weeks) due to technological advancements[20].
In the present study, the arterial conduit group comprised multiple arterial graft subtypes. This grouping strategy was adopted for three reasons. First, these grafts share similar anatomical and physiological characteristics, with most originating from visceral arteries and exhibiting only minor differences in luminal diameter. Second, the sample size for each arterial subtype was too small for meaningful statistical analysis, and combining them into a single group improved statistical validity. Third, the grouping was based on the origin of the vascular conduit, consistent with the primary objective of evaluating donor-site morbidity. We acknowledge that these grafts differ substantially in caliber, wall structure, usable length, hemodynamic properties, and thrombogenic risk. Combining all arterial conduits into a single group may have obscured clinically meaningful differences among arterial graft subtypes. However, formal subgroup analyses were not feasible because of the limited sample size. The number of patients in each arterial graft subtype was too small to provide sufficient statistical power for reliable comparisons. To provide a preliminary assessment of the outcomes associated with each arterial graft subtype, we performed exploratory descriptive analyses across all graft variants. Only one case of HAT was observed in the SpA subgroup. Nevertheless, comparisons among arterial graft subtype should be interpreted with caution and require validation in larger studies.
In this study, we retrospectively reviewed 34 cases of GSV conduits and 33 cases of arterial conduits in PLDLT, representing the largest cohort reported to date. HA patency and the incidence of HAT are key indicators for evaluating the performance of VGs. Our study compared the short-term and long-term outcomes between the GSV and arterial conduit groups in PLDLT via HAB. The results showed no significant differences between the two groups in terms of the risk of Clavien-Dindo classification III or above, such as HAT, primary graft nonfunction, graft loss, and death. The overall incidence of HAT in this study was 4.5%, including two cases (5.9%) of HAT in the GSV conduit group and one case (3.0%) in the arterial conduit group, with no significant inter-group difference. Previous studies have reported that the incidence of HAT in children undergoing LT varied between 1.7% and 11%[21,22]. The thrombi of both cases in the GSV conduit group were located within the GSV, whereas that of the one case in the arterial conduit group was located within the recipient’s dissecting artery. GSV has a thin wall and can dilate significantly under the arterial blood pressure. The artery may present with plaques and dissection. In addition, most VGs are harvested from adult donors, resulting in a relatively larger vessel caliber compared with the vascular diameter of pediatric recipients, leading to expanded VGs relative to the adjacent HA after revascularization and local turbulence. All of these can contribute to VG local shear microgradients and blood flow disruptions with subsequent thrombus formation[23,24]. Meanwhile, studies have found that blood clots were located in the distal and downstream parts of the damaged area, leaving most upstream damaged areas uncovered[25,26]. Compared with the physiological arterial shear rate, the thrombus growth rate was significantly accelerated under a pathological shear rate[26,27]. These may explain the occurrence of HAT. The potential association between conduit morphological characteristics, hemodynamic patterns, and thrombotic risk remains speculative. Although arterial grafts and venous grafts differ intrinsically in vessel wall structure, compliance, and flow adaptation, no quantitative imaging or hemodynamic data were available to validate these proposed mechanisms. Future studies incorporating intraoperative Doppler flow monitoring, computational fluid dynamics, and vascular remodeling evaluation are needed to provide direct mechanistic insights into graft-related thrombosis in PLDLT.
Unfortunately, all three recipients with HAT in this study died, mainly from liver failure, which was in line with a previous report[1]. Due to the small number of HAT cases in this study, risk factors related to HAT could not be analyzed. According to previous studies, the occurrence of HAT was not only related to the small size of the HA of the donor and/or recipient but also to complex arterial reconstruction and pre-transplant TACE[28-30]. In this study, only one recipient with a history of pre-transplant TACE developed HAT, which might be related to the small sample size. Further study is required to investigate the risk factors for HAT.
Furthermore, the Kaplan-Meier survival analysis revealed no significant differences between the two groups in terms of HA patency, graft survival, and patient survival. In addition, although the pediatric patients in this study underwent a complex HA surgical procedure, the graft outcomes and patient survival were not inferior to those of other major transplant centers worldwide[31-33].
The results of univariate and multivariate analyses showed that the HAB procedure was not a risk factor for survival. However, due to the limited sample size of this study, the relevant results need to be further validated with larger sample sizes. Prospective, randomized, multicenter, large-sample studies are warranted in the future to verify our findings.
The present study investigated postoperative complications related to GSV donor sites. Several types of complications, including wound infection, scarring, and long-standing peripheral edema, were reported in the GSV conduit group, consistent with a study by Bhatti et al[6]. Persistent lower-extremity edema following GSV harvest may limit daily physical activity, causes chronic limb heaviness and discomfort, and over time, progress to superficial varicosities or chronic venous insufficiency, thereby adversely affecting donors’ mobility and exercise tolerance[34]. Additionally, more than 50% of the GSV graft donors had severe scarring, with a VSS score of > 7[35]. Most GSV conduit donors were female living liver donors, with a median age of 32 years, a population in which cosmetic outcomes may be of particular concern. Elevated VSS scores indicate pronounced scar hypertrophy and pigmentation changes, which negatively affect body image and contribute to psychological distress. Furthermore, donor-site morbidity may adversely affect social functioning and overall quality of life[36]. Two harvest techniques for GSV harvesting are applied clinically: (1) The conventional open approach; and (2) Minimally invasive endoscopic vein harvesting (EVH). Compared with the open technique, EVH requires only small skin incisions, reduces wound-related complications such as infection, severe edema, and hypertrophic scarring, minimizes soft tissue trauma, and facilitates postoperative recovery. However, EVH is associated with additional costs, require specialized surgical expertise, and is not universally available in pediatric liver transplant centers[37]. Taken together, when arterial grafts satisfy all vascular matching criteria, they should be prioritized to avoid GSV donor-site morbidity. GSV conduits should be considered only when suitable arterial grafts are unavailable, with EVH preferred where the necessary expertise and resources are available.
CONCLUSION
In summary, no statistically significant differences were observed between arterial and GSV conduits for HAB in PLDLT. Both may serve as viable grafts for HAB, which awaits validation through larger-scale research. The limitations of our study included its single-center setting and retrospective study design. Even though our study boasts the largest sample size reported for this research topic to date, the cohort remains relatively small given the incidence of the primary endpoint (HAT). This inevitably results in low statistical power and an elevated type II error rate (β). Consequently, the absence of a statistically significant difference may stem from insufficient sample size. Furthermore, given that conduit selection was non-randomized, patients receiving arterial conduits may differ systematically from those receiving GSV conduits in ways not captured by baseline variables. Accordingly, substantial selection bias may exist in this study. Such bias could artificially narrow or widen the true intergroup difference in HAT incidence and vascular patency. Moreover, propensity score matching or inverse probability weighting was not feasible because of the limited sample size. The inability to perform these adjustments constituted a major limitation when comparing the efficacy of arterial conduits with GSV conduits. Thus, large-scale, multicenter, prospective randomized studies are needed.
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P-Reviewer: Agussalim D, Associate Professor, PhD, Indonesia; Lampridis S, Chief Physician, MD, United Kingdom S-Editor: Luo ML L-Editor: A P-Editor: Lei YY
