Cortes-Mejia NA, Bejarano-Ramirez DF, Guerra-Londono JJ, Trivino-Alvarez DR, Tabares-Mesa R, Vera-Torres A. Portal vein arterialization in 25 liver transplant recipients: A Latin American single-center experience. World J Transplant 2024; 14(2): 92528 [PMID: 38947972 DOI: 10.5500/wjt.v14.i2.92528]
Corresponding Author of This Article
Alonso Vera-Torres, FACS, FEBS, MD, Chief Doctor, Professor, Surgeon, Transplant and Hepatobiliary Surgery Department, Fundacion Santa Fe de Bogota, Cra. 7 #117-15. Fourth Floor, Transplantation Office, Bogota 110111, Colombia. alonso.vera@fsfb.org.co
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2024; 14(2): 92528 Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.92528
Portal vein arterialization in 25 liver transplant recipients: A Latin American single-center experience
Nicolas Andres Cortes-Mejia, Diana Fernanda Bejarano-Ramirez, Juan Jose Guerra-Londono, Diego Rymel Trivino-Alvarez, Raquel Tabares-Mesa, Alonso Vera-Torres
Nicolas Andres Cortes-Mejia, Juan Jose Guerra-Londono, Division of Anesthesiology, Critical Care Medicine, and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Nicolas Andres Cortes-Mejia, Diana Fernanda Bejarano-Ramirez, Diego Rymel Trivino-Alvarez, Alonso Vera-Torres, Transplant and Hepatobiliary Surgery Department, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
Raquel Tabares-Mesa, General Surgery Department, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
Author contributions: Vera-Torres A is the Transplant Surgeon and director of the Transplantation program at Fundacion Santa Fe de Bogota, he proposed and performed the technique for these liver transplant recipients; Cortes-Mejia NA, Vera-Torres A, and Bejarano-Ramirez DF designed the research study; Cortes-Mejia NA and Trivino-Alvarez DR performed the primary literature review; Cortes-Mejia NA performed data extraction; Bejarano-Ramirez DF and Cortes-Mejia NA performed the statistical analysis; Vera-Torres A, Cortes-Mejia NA and Guerra-Londono JJ wrote the manuscript; Vera-Torres A, and Guerra-Londono JJ were responsible for revising the manuscript for important intellectual content; and all authors read and approved the final version. Tabares-Mesa R is a general surgeon, and she drew the pictures illustrating the surgical intervention analyzed during this manuscript.
Institutional review board statement: Data collection, analysis, and publication were approved by the Fundacion Santa Fe de Bogota Corporative Ethics Committee for Research (CCEI) (act CCEI-15197-2023) on March 28, 2023. The authors acted according to the Helsinki and Istanbul Declarations of ethical principles.
Informed consent statement: Because of its retrospective nature, the requirement for written consent was waived by the CCEI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: For further supplementary, multimedia, statistical code, and dataset, please contact the corresponding author at email address rural.trasplantes@fsfb.org.co.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alonso Vera-Torres, FACS, FEBS, MD, Chief Doctor, Professor, Surgeon, Transplant and Hepatobiliary Surgery Department, Fundacion Santa Fe de Bogota, Cra. 7 #117-15. Fourth Floor, Transplantation Office, Bogota 110111, Colombia. alonso.vera@fsfb.org.co
Received: January 28, 2024 Revised: February 19, 2024 Accepted: April 28, 2024 Published online: June 18, 2024 Processing time: 137 Days and 9.9 Hours
Abstract
BACKGROUND
Portal vein arterialization (PVA) has been used in liver transplantation (LT) to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis (PVT). The effect of PVA on portal perfusion and primary graft dysfunction (PGD) has not been assessed.
AIM
To examine the outcomes of patients who required PVA in correlation with their LT procedure.
METHODS
All patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were analyzed. To account for the time-sensitive effects of graft perfusion, patients were classified into two groups: prereperfusion (pre-PVA), if the arterioportal anastomosis was performed before graft revascularization, and postreperfusion (post-PVA), if PVA was performed afterward. The pre-PVA rationale contemplated poor portal hemodynamics, severe vascular steal, or PVT. Post-PVA was considered if graft hypoperfusion became evident. Conservative interventions were attempted before PVA.
RESULTS
A total of 25 cases were identified: 15 before and 10 after graft reperfusion. Pre-PVA patients were more affected by diabetes, decompensated cirrhosis, impaired portal vein (PV) hemodynamics, and PVT. PGD was less common after pre-PVA (20.0% vs 60.0%) (P = 0.041). Those who developed PGD had a smaller increase in PV velocity (25.00 cm/s vs 73.42 cm/s) (P = 0.036) and flow (1.31 L/min vs 3.34 L/min) (P = 0.136) after arterialization. Nine patients required PVA closure (median time: 62 d). Pre-PVA and non-PGD cases had better survival rates than their counterparts (56.09 months vs 22.77 months and 54.15 months vs 31.91 months, respectively).
CONCLUSION
This is the largest report presenting PVA in LT. Results suggest that pre-PVA provides better graft perfusion than post-PVA. Graft hyperperfusion could play a protective role against PGD.
Core Tip: Guaranteeing adequate graft perfusion is essential to obtain optimal outcomes after liver transplantation (LT). This retrospective single-center study analyzed 25 cases of portal vein arterialization (PVA) for portal flow optimization in LT. To account for the time-sensitive effect, cases were classified into two groups: prereperfusion (pre-PVA) if the arterioportal anastomosis was performed before graft revascularization and postreperfusion (post-PVA) if PVA was performed afterward. We found that pre-PVA yields better results than post-PVA and that hyperperfusion could play a protective role against graft dysfunction. Currently, this is the largest case series studying PVA during LT.
