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1
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Hepatic Artery Reconstruction in Living Donor Liver Transplantation With the Radial Artery Interpositional Graft. Transplant Proc 2021; 53:1659-1664. [PMID: 33641934 DOI: 10.1016/j.transproceed.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Reconstitution of hepatic artery inflow is essential for a successful liver transplantation. Living donor transplantation presents additional challenges in the form of a short and small donor vessel stump, exacerbating the poor surgical access for microsurgery. Few reports have described the use of the radial artery as an interposition graft in liver transplantation; we present a series of 6 cases and discuss the technical merits of this procedure. METHODS Retrospective review of consecutive patients undergoing living donor liver transplantation from December 2015 to December 2019 was performed. Demographics, operative details, and postoperative outcomes were reviewed. RESULTS Twenty-two patients underwent living donor liver transplantation. Radial artery interposition grafting was used in 6 cases, including 1 salvage case for hepatic artery thrombosis. One patient developed hepatic artery stenosis (2 weeks postoperatively) that was conservatively managed. After radial artery grafting, all patients had normal resistive indices on duplex ultrasonography at up to 20 months postoperatively. The mean follow-up was 15.2 months. CONCLUSION When faced with a significantly short vessel stump or caliber mismatch, radial artery interpositional grafting is a safe and useful technique for reducing tension and overcoming vessel size mismatch in hepatic artery reconstruction.
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2
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King D, Neil D, Forde C, Mirza D, Mergental H, Elsharkawy AM. Aortic conduit aneurysm and enteric fistula formation in a post-liver transplant patient: A potential causative role for cytomegalovirus? Transpl Infect Dis 2019; 21:e13092. [PMID: 30972849 DOI: 10.1111/tid.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022]
Abstract
Hepatic arterial aortic conduits can be used as an alternative means of revascularizing the donor liver when the native recipient hepatic artery (HA) cannot be used. Cytomegalovirus (CMV) is a common Herpesviridae infection in patients who have undergone solid organ transplants. It can be asymptomatic but may cause fever and invasive disease affecting any organ system. Here we describe the first case in the literature of an aortic conduit aneurysm and concurrent CMV viremia following liver transplantation. We speculate on a causative role for CMV in the development of the aneurysm.
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Affiliation(s)
- Dominic King
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Desley Neil
- Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Colm Forde
- Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Darius Mirza
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Hynek Mergental
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Ahmed M Elsharkawy
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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3
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Nacoti M, Ruggeri GM, Colombo G, Bonanomi E, Lussana F. Thrombosis prophylaxis in pediatric liver transplantation: A systematic review. World J Hepatol 2018; 10:752-760. [PMID: 30386468 PMCID: PMC6206147 DOI: 10.4254/wjh.v10.i10.752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To review current literature of thrombosis prophylaxis in pediatric liver transplantation (PLT) as thrombosis remains a critical complication.
METHODS Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library (CENTRAL) databases until March 2018. The search was supplemented by manually reviewing the references of included studies and the references of the main published systematic reviews on thrombosis and PLT. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describing less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed study selection independently, with disagreements solved through discussion and by the opinion of a third reviewer when necessary.
RESULTS Nine retrospective studies were included in this review. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies. We found an incidence of portal vein thrombosis (PVT) ranging from 2% to 10% in pediatric living donor liver transplantation (LDLT) and from 4% to 33% in pediatric deceased donor liver transplantation (DDLT). Hepatic artery thrombosis (HAT) was observed mostly in mixed LDLT and DDLT pediatric population with an incidence ranging from 0% to 29%. In most of the studies Doppler ultrasonography was used as a first line diagnostic screening for thrombosis. Four different surgical techniques for portal vein anastomosis were reported with similar efficacy in terms of PVT reduction. Reduced size liver transplant was associated with a low risk of both PVT (incidence 4%) and HAT (incidence 0%, P < 0.05). Similarly, aortic arterial anastomosis without graft interposition and microsurgical hepatic arterial reconstruction were associated with a significant reduced HAT incidence (6% and 0%, respectively). According to our inclusion and exclusion criteria, we did not find eligible studies that evaluated pharmacological prevention of thrombosis.
CONCLUSION Poor quality retrospective studies show the use of tailored surgical strategies might be useful to reduce HAT and PVT after PLT; prospective studies are urgently needed.
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Affiliation(s)
- Mirco Nacoti
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Giulia Maria Ruggeri
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Giovanna Colombo
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Ezio Bonanomi
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Federico Lussana
- Hematology and Bone Marrow Transplant Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
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4
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Increased risk of vascular thrombosis in pediatric liver transplant recipients with thrombophilia. J Surg Res 2015; 199:671-5. [DOI: 10.1016/j.jss.2015.07.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 12/26/2022]
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5
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Hibi T, Nishida S, Levi DM, Sugiyama D, Fukazawa K, Tekin A, Fan J, Selvaggi G, Ruiz P, Tzakis AG. Long-term deleterious effects of aortohepatic conduits in primary liver transplantation: proceed with caution. Liver Transpl 2013; 19:916-25. [PMID: 23897778 DOI: 10.1002/lt.23689] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 05/19/2013] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Taizo Hibi
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, FL 33331, USA
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6
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Mabrut JY, Abdullah SS, Rode A, Bourgeot JP, Eljaafari A, Baulieux J, Ducerf C. Cryopreserved iliac artery allograft for primary arterial revascularization in adult liver transplantation. Clin Transplant 2011; 26:E12-6. [PMID: 21919967 DOI: 10.1111/j.1399-0012.2011.01518.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arterial allograft represents a material of choice for primary arterial revascularization in liver transplantation (LT) when interposition of a vascular conduit is required. In case of non-availability of such graft, the use of cryopreserved vessels should be an interesting option. Three patients were grafted using a cryopreserved iliac artery allograft (CIAA) previously harvested and stored at -140°C in a tissue bank. An auxiliary partial LT was performed in one patient for acute liver failure. During follow-up, an efficient regeneration of the native hemi-liver was observed while atrophy of the auxiliary graft occurred, leading to functional portal vein and hepatic artery thrombosis at six and nine months, respectively. Two other patients presented with celiac trunk compression because of arcuate ligament without available arterial allograft in the donor. Late arterial thrombosis occurred at six months in one patient without impairment of graft function. The last patient was alive and symptom free 29 months after LT with a patent cryopreserved arterial conduit. Our preliminary results suggest that CIAA might represent an efficient solution as vessel interposition for primary arterial hepatic revascularization in LT setting when no other suitable graft is available. However, long-term patency of CIAA remains questionable.
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Affiliation(s)
- Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon Cedex, France.
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7
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Backes A, Gibelli N, Tannuri A, Santos M, Pinho-Apezzato M, Andrade W, Maksoud-Filho J, Queiróz A, Tannuri U. Hepatic Artery Graft in Pediatric Liver Transplantation: Single-Center Experience With 58 Cases. Transplant Proc 2011; 43:177-80. [DOI: 10.1016/j.transproceed.2010.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kóbori L, Németh T, Nagy P, Dallos G, Sótonyi P, Fehérvári I, Nemes B, Görög D, Patonai A, Monostory K, Doros A, Sárváry E, Fazakas J, Gerlei Z, Benkő T, Piros L, Járay J, Jong K. Experimental results and clinical impact of using autologous rectus fascia sheath for vascular replacement. Acta Vet Hung 2008; 56:411-20. [PMID: 18828492 DOI: 10.1556/avet.56.2008.3.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vascular complications are major causes of graft failure in liver transplantation. The use of different vascular grafts is common but the results are controversial. The aim of this study was to create an 'ideal' arterial interponate for vascular replacements in the clinical field. An autologous, tubular graft prepared from the posterior rectus fascia sheath was used for iliac artery replacement in dogs for 1, 3, 6 and 12 months. Forty-one grafts were implanted and immunosuppression was used in separate groups. The patency rate was followed by Doppler ultrasound. Thirty-seven grafts remained patent, 2 cases with thrombosis and 2 cases with stenosis occurred. There was no evidence of necrosis or aneurysmatic formation. The histological analysis included conventional light microscopic and immunohistochemical examinations for CD34 and factor VIII. The explanted grafts showed signs of arterialisation, appearance of elastin fibres, and smooth muscle cells after 6 months. Electron microscopy showed intact mitochondrial structures without signs of hypoxia. In conclusion, the autologous graft presents acceptable long-term patency rate. It is easy to handle and the concept of beneficial presence of the anti-clot mesothelium until endothelialisation seems to work. The first clinical use was already reported by our group with more than 2 years survival.
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Affiliation(s)
- László Kóbori
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Tibor Németh
- 2 Szent István University Department of Surgery and Ophthalmology, Faculty of Veterinary Science Budapest Hungary
| | - Péter Nagy
- 3 Semmelweis University 1st Department of Pathology and Cancer Research Budapest Hungary
| | - Gábor Dallos
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Péter Sótonyi
- 4 Semmelweis University Department of Vascular and Cardiac Surgery Budapest Hungary
| | - Imre Fehérvári
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Balázs Nemes
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Dénes Görög
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Attila Patonai
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Katalin Monostory
- 5 Chemical Research Institute of the Hungarian Academy of Sciences Budapest Hungary
| | - Attila Doros
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Enikő Sárváry
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - János Fazakas
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Zsuzsanna Gerlei
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Tamás Benkő
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - László Piros
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Jenő Járay
- 1 Semmelweis University Transplantation and Surgical Department H-1082 Budapest Baross u. 23-25 Hungary
| | - Koert Jong
- 6 University Medical Hospital of Groningen Department of Hepatobiliary Surgery and Liver Transplantation Groningen The Netherlands
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9
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Wille T, de Groot H, Rauen U. Improvement of the cold storage of blood vessels with a vascular preservation solution. Study in porcine aortic segments. J Vasc Surg 2008; 47:422-31. [DOI: 10.1016/j.jvs.2007.09.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 09/17/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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10
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Fink MA, Jones RM. The use of a composite graft of iliac artery and inferior mesenteric vein in liver transplantation. Transpl Int 2005; 19:81-3. [PMID: 16359381 DOI: 10.1111/j.1432-2277.2005.00237.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Innovation may be required for satisfactory arterial reconstruction in liver transplantation, particularly when the vessels obtained from the donor are inadequate. We have used a composite graft of donor iliac artery and recipient inferior mesenteric vein (IMV) between the infrarenal aorta and donor hepatic artery. Postoperative liver function was satisfactory, with normal daily duplex ultrasound scans for the first 2 weeks. At 4 years follow up, graft function is normal, a duplex ultrasound scan shows normal arterial flow and no dilatation of the composite graft, and a magnetic resonance angiogram reveals no evidence of dilatation or thrombosis of the composite graft. This is one of the few reported cases in which a composite graft has been used to arterialize the allograft in liver transplantation. A composite graft of iliac artery and IMV provided a satisfactory outcome in this patient and may be a valuable addition to the arterial grafts available to the liver transplant surgeon.
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11
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Jara P, Hierro L. [Pediatric liver transplantation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:493-508. [PMID: 16185585 DOI: 10.1157/13079008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There are no differences in results between pediatric liver transplantation and liver transplantation in adults. The reverts of the liver disease prior to transplantation (particularly the need of intensive care is the best predictor of perspective mortality. Therefore, liver transplantation in children should be indicated prior a severe decompensation of the disease.
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Affiliation(s)
- P Jara
- Servicio de Hepatología y Trasplantes, Hospital Infantil Universitario La Paz, Madrid, Spain.
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12
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Heffron TG, Welch D, Pillen T, Fasola C, Redd D, Smallwood GA, Martinez E, Atkinson G, Guy M, Nam C, Henry S, Romero R. Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulation. Pediatr Transplant 2005; 9:486-90. [PMID: 16048601 DOI: 10.1111/j.1399-3046.2005.00327.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The risk of hepatic artery thrombosis (HAT) after pediatric liver transplantation (PLT) has been reported to range from 0 to 25%. We report our experience focusing on the interrelationships between risk factors, surgical technique and the incidence of HAT after liver transplantation in the pediatric age group. From February 18, 1997 to December 31, 2003, 150 consecutive liver transplants were performed in 132 pediatric patients. There were similar numbers of whole grafts when compared with partial grafts, 80 (53.3%) vs. 70 (46.7%), p = 0.30. Four grafts (2.7%) developed HAT. Of the grafts with HAT, three were successfully revascularized within the first 24 h. Only one graft (0.66%) was lost to HAT. A single surgeon utilizing 3.5-6.0 magnification loupes performed all but one hepatic arterial anastomoses. All patients were followed postoperatively by a daily ultrasound protocol and with anticoagulation of aspirin and alprostadil only. Living and deceased donor left lateral segment grafts had an increased rate of HAT when compared with whole liver grafts. HAT with subsequent graft loss may be minimized in PLT with the use of surgical loupes only, anticoagulation utilizing aspirin, alprostadil, and daily ultrasounds.
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Affiliation(s)
- Thomas G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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13
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Mizuno S, Yokoi H, Isaji S, Yamagiwa K, Tabata M, Shimono T, Miya F, Takada Y, Uemoto S. Using a radial artery as an interpositional vascular graft in a living-donor liver transplantation for hepatocellular carcinoma. Transpl Int 2005; 18:408-411. [PMID: 15773959 DOI: 10.1111/j.1432-2277.2004.00049.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
With increasing numbers of living-donor liver transplantations (LDLTs) for hepatocellular carcinoma (HCC), cases with some arterial troubles are encountered; because most HCC cases waiting for LDLT have undergone interventional treatments. In these patients, the reconstruction of the graft artery needs to be planned preoperatively. We report a 52-year-old male, with hepatitis C-related liver cirrhosis and advanced HCC, who for 4 years repeatedly underwent continuous intraarterial chemotherapy through an implanted reservoir port. A suitable artery was not available for arterial reconstruction and the patient underwent LDLT using an autologous radial artery conduit based on the infrarenal aorta. Postoperatively, the patient is well with normal liver function and efficient arterial flow. Autologous radial artery can be safely and successfully used as an aortic-based arterial conduit when HCC patients waiting for LDLT have undergone long-term repeated intraarterial chemotherapy.
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Affiliation(s)
- Shugo Mizuno
- First Department of Surgery, Mie University School of Medicine, Tsu, Japan
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14
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Nishida S, Vaidya A, Kato T, Nakamura N, Madariaga J, Tzakis A. Use of donor aorta for arterial reconstruction in paediatric liver and multivisceral transplantation. Br J Surg 2004; 91:705-8. [PMID: 15164438 DOI: 10.1002/bjs.4550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Arterial reconstruction remains the most important technical issue in paediatric transplantation. The arteries of paediatric donors as well as recipients are small and friable. The aim of this study was to assess the use of the donor aorta as a conduit for arterial reconstruction in paediatric liver and multivisceral transplantation. METHODS Between June 1994 and January 2002, 284 paediatric transplants, including 197 cadaveric liver and multivisceral transplants, were performed in children at this centre. Of these, 41 (20.8 per cent), including nine cadaveric liver transplants and 32 multivisceral transplants, were revascularized by donor aortic reconstruction. Patient demographics, types of donor arterial reconstruction, technical complications and incidence of hepatic artery thrombosis were reviewed. RESULTS None of the 41 donor aortic reconstructions used in revascularization of paediatric liver and multivisceral transplants thrombosed. There were no bleeding complications and no pseudoaneurysms developed. CONCLUSION Arterial reconstruction using donor aorta is a useful option with a low incidence of thrombosis in paediatric transplantation.
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Affiliation(s)
- S Nishida
- Division of Transplantation, Department of Surgery, University of Miami, School of Medicine, Miami, Florida, USA.
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15
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Kóbori L, Németh T, Nemes B, Dallos G, Sótonyi P, Fehérvári I, Patonai A, Slooff MJH, Járay J, De Jong KP. Experimental vascular graft for liver transplantation. Acta Vet Hung 2003; 51:529-37. [PMID: 14680065 DOI: 10.1556/avet.51.2003.4.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hepatic artery thrombosis is a major cause of graft failure in liver transplantation. Use of donor interponates are common, but results are controversial because of necrosis or thrombosis after rejection. Reperfusion injury, hypoxia and free radical production determinate the survival. The aim of the study was to create an 'ideal' arterial interponate. Autologous, tubular graft lined with mesothelial cells, prepared from the posterior rectus fascia sheath, was used for iliac artery replacement in eight mongrel dogs for six months under immunosuppression. Patency rate was followed by Doppler ultrasound. Eight grafts remained patent and another two are patent after one year. The patency rate was good (median Doppler flow: 370 cm/sec) and there was no necrosis, thrombosis or aneurysmatic formation. The grafts showed viable morphology with neoangiogenesis, appearance of elastin, smooth muscle and endothelial cells. Electron microscopy showed intact mitochondrial structures without signs of hypoxia. Tissue oxygenation was good in all cases with normal (< 30 ng/ml) myeloperoxidase production. In conclusion, this autologous graft presents good long-term patency rate. Viability, arterialisation and low thrombogenicity are prognostic factors indicating usability of the graft in the clinical practice without the risk of rejection. Further investigations such as cell cultures and standardisation are necessary.
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Affiliation(s)
- L Kóbori
- Transplantation and Surgical Department, Semmelweis University, H-1082 Budapest, Baross u. 23-25, Hungary.
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16
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Cheng YF, Chen CL, Jawan B, Huang TL, Chen TY, Chen YS, Wang CC, de Villa V, Wang SH, Wah CK, Chiang YC, Eng HL, Lee TY, Goto S. Multislice computed tomography angiography in pediatric liver transplantation. Transplantation 2003; 76:353-7. [PMID: 12883192 DOI: 10.1097/01.tp.0000074315.97151.ac] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preoperative delineation of any vascular anomalies offers planning for possible alteration of surgical procedures, especially in pediatric recipients undergoing living-related liver transplantation. PURPOSE We assess the efficacy of three-dimensional (3D) multislice computed tomography (CT) angiography in the hope of replacing conventional angiography as the pretransplant evaluation of the hepatic vascular system for potential recipients of liver transplantation. METHODS 3D CT angiography was performed in 38 children with biliary atresia. Conventional angiography was also performed in the first 15 patients. Twelve patients underwent living-related liver transplantation. The findings on 3D CT angiography were compared with conventional angiography and operative findings. RESULTS 3D CT angiography was successfully performed in 37 pediatric patients. All findings of 3D CT angiography on hepatic artery, portal vein, and inferior vena cava paralleled those of catheter angiography and operative findings. Four patients were unsuitable to receive living grafts because of pathologic insults of the hepatic artery (one patient) and the portal vein (three patients). Three patients were advised to undergo a venous graft for portal anastomoses. Eight patients demonstrated portosystemic shunts that may require closure. CONCLUSION 3D CT angiography proves to be a better tool in the demonstration of the vascular system and identification of pathologic insults in pediatric patients. It is superior to conventional angiography because it is less invasive, more convenient, and more efficient in providing thorough preoperative information that would have a major impact on patient selection and surgical planning.
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Affiliation(s)
- Yu Fan Cheng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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17
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Chen TY, Chen CL, Huang TL, Chen YS, Wang CC, de Villa VH, Chiang YC, Jawan B, Cheng YF. Noninvasive multislice CT angiography in pediatric liver transplantation: a novel application. Transplant Proc 2003; 35:62-3. [PMID: 12591308 DOI: 10.1016/s0041-1345(02)03817-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- T Y Chen
- Department of Diagnostic Radiology and Liver Transplant Program, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan
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18
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Sellers MT, Haustein SV, McGuire BM, Jones C, Bynon JS, Diethelm AG, Eckhoff DE. Use of preserved vascular homografts in liver transplantation: hepatic artery aneurysms and other complications. Am J Transplant 2002; 2:471-5. [PMID: 12123215 DOI: 10.1034/j.1600-6143.2002.20513.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hepatic artery aneurysms/pseudoaneurysms (HAAs) are rare but serious complications after orthotopic liver transplantation (OLT). Revascularization should accompany aneurysmectomy if possible and is more feasible if the aneurysm presents late after transplantation. The optimal conduits for revascularization in this situation are not known. Two patients with hepatic artery aneurysms/pseudoaneurysms who had aneurysmectomy and revascularization with third-party cadaveric iliac arterial grafts 1 and 4 years after OLT are presented in detail, with an emphasis on the preservation method used for the grafts. Both livers were successfully revascularized with arterial grafts preserved for 21 and 26 days after procurement. Hepatic patency was documented in both 5 and 6 months after repair; graft function has remained normal 13 and 32 months after repair. Third-party vessels preserved for shorter periods have been used successfully in four other situations, including living-donor liver transplantation, and are briefly discussed. In conclusion, properly preserved vascular homografts are useful in LT for purposes other than initial vascular reconstruction. They also provide an excellent vascular conduit in recipients of livers from other (possibly living) donors.
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Affiliation(s)
- Marty T Sellers
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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19
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Tang SS, Shimizu T, Kishimoto R, Kodama Y, Miyasaka K. Analysis of portal venous waveform after living-related liver transplantation with pulsed Doppler ultrasound. Clin Transplant 2001; 15:380-7. [PMID: 11737113 DOI: 10.1034/j.1399-0012.2001.150603.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We evaluate the portal venous waveform (PVW) with pulsed Doppler ultrasound (US) after living-related liver transplantation (LRLT) and correlate it with subsequent abnormalities. In the first 2 wk after LRLT, pulsed Doppler US demonstrated three types of PV waveform (PVW) in 33 recipients: non-phasic PVW in 19 patients, pulsatile in 10, and turbulent in 4. In the pulsatile PVW group, arterio-portal (A-P) shunt was confirmed in three grafts by either arteriograhy or computed tomography during hepatic arteriography. A severe stenosis in the grafted vein was confirmed in one case by both US and venography. The pulsatile PVW in the remaining six cases spontaneously disappeared and turned to the non-phasic PVW without treatment. The graft volume/liver standard volume (GV/SV) ratio was significantly smaller in the pulsatile PV waveform group than in the non-phasic PVW group (p<0.01). In the turbulent PVW group, aneurysmal-like dilatation of the portal vein at the umbilical portion was formed in 3 of the 4 patients. The pulsatile waveform in the PV is frequently observed with pulsed Doppler after LRLT, especially in patients that received small grafts. We should keep in mind that they often disappear without any treatment, although some examples of pulsatile waveforms represent vascular complications.
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Affiliation(s)
- S S Tang
- Department of Radiology, Hokkaido University School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-8638, Japan.
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20
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Kóbori L, Dallos G, Gouw AS, Németh T, Nemes B, Fehérvári I, Tegzess AM, Slooff MJ, Perner F, De Jong KP. Experimental autologous substitute vascular graft for transplantation surgery. Acta Vet Hung 2001; 48:355-60. [PMID: 11402719 DOI: 10.1556/avet.48.2000.3.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vascular complications in liver transplantation are a major cause of graft failure and mortality. The aim of the study was to create autologous vascular graft without risk of rejection. Posterior rectus fascia sheath lined with peritoneum was used for iliac artery replacement in seven mongrel dogs. The patency was followed by palpation and Doppler ultrasound. The grafts were removed after one month. Five grafts remained patent. The Doppler showed good, relatively increased flow (median flow rate: 383 cm/sec) after one month in all of the cases. Slight increase in diameter was present in all cases. By microscopy the five patent grafts showed viable morphology, fibroblasts, smooth muscle cells and thin fibrin layer in the wall. The grafts were lined partially with a neoendothelial monolayer and a thin fibrin layer. In conclusion, this graft presents an acceptable patency rate and low thrombogenicity, and could be useful in transplantation. Further investigations are needed to study the effect of immunosuppression and rejection on long-term morphology and patency of the grafts.
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Affiliation(s)
- L Kóbori
- Transplantation and Surgical Department, Semmelweis Medical University, H-1082 Budapest, Baross u. 23-25, Hungary.
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21
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Asakura T, Ohkohchi N, Orii T, Koyamada N, Satomi S. Arterial reconstruction using vein graft from the common iliac artery after hepatic artery thrombosis in living-related liver transplantation. Transplant Proc 2000; 32:2250-1. [PMID: 11120153 DOI: 10.1016/s0041-1345(00)01787-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T Asakura
- Tohoku University School of Medicine, Sendai, Japan
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22
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Schindel DT, Dunn SP, Casas AT, Falkenstein K, Billmire DF, Vinocur CD, Weintraub WH. Pediatric recipients of three or more hepatic allografts: results and technical challenges. J Pediatr Surg 2000; 35:297-300; discussion 301-2. [PMID: 10693684 DOI: 10.1016/s0022-3468(00)90028-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Children who require a liver transplant at an early age risk chronic allograft rejection (CAR) and other causes of allograft loss. Multiple retransplants may be required for long-term patient survival. The authors evaluate this approach based on our results and technical difficulties. METHODS Charts of 7 children who received 3 or more liver transplants from 1989 to the present were reviewed retrospectively. RESULTS A total of 151 children required liver transplantation at our institution since 1989. Of these, 4 boys and 3 girls (mean age, 6.2 years; range, 3 to 14 years) have received 3 or more allografts. The etiology of liver failure for the penultimate allograft was CAR (n = 6) and hepatic artery thrombosis (HAT; n = 1). Five cases required modification of portal vein or hepatic artery anastomoses. Two patients with vena caval strictures required supradiaphragmatic vena caval reconstruction. The original Roux-en-Y limb was adequate for biliary reconstruction in all cases. Five children currently are alive (survival rate, 71%) with good graft function having had a mean follow-up of 23 months (range, 2 to 48 mos.). CONCLUSIONS The operative procedure for the multiple hepatic transplant child is challenging. The transplant team must be prepared for intraoperative issues such as extended organ ischemia time during hepatectomy, extensive blood loss, and potential need for creative organ revascularization techniques. Overall, multiple retransplant results are good and justify the use of multiple allografts.
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Affiliation(s)
- D T Schindel
- Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA
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23
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Nakatsuka T, Takushima A, Harihara Y, Makuuchi M, Kawarasaki H, Hashizume K. Versatility of the inferior epigastric artery as an interpositional vascular graft in living-related liver transplantation. Transplantation 1999; 67:1490-2. [PMID: 10385093 DOI: 10.1097/00007890-199906150-00019] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have used the recipient inferior epigastric artery as an interpositional vascular graft in living-related liver transplantation cases with hepatic artery obstruction, enabling us to restore the arterial inflow sufficiently to the transplanted liver. The inferior epigastric artery is easy to access during abdominal surgery. Easy to harvest, it is anatomically constant and has a caliber equivalent to that of the hepatic artery. Donor site morbidity is negligible. There is no risk of rejection because of the autograft. There has been no report on the availability of the inferior epigastric artery for hepatic artery reconstruction. We consider this vessel as a good option for an arterial conduit in case of the inadequacy or thrombosis of the hepatic artery in living-related liver transplantation.
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Affiliation(s)
- T Nakatsuka
- Department of Plastic and Reconstructive Surgery, Saitama Medical School, Iruma, Japan
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24
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Eid A, Lyass S, Venturero M, Ilan Y, Safadi R, Zamir G, Berlatzky Y, Jurim O. Vascular complications post orthotopic liver transplantation. Transplant Proc 1999; 31:1903-4. [PMID: 10371994 DOI: 10.1016/s0041-1345(99)00148-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Eid
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
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