Uragoda Appuhamilage B, Gupta S, Parente A, Srinivasan P, Menon K, Hakeem AR. Systematic review and meta-analysis of the role of aorto-hepatic conduits in liver transplant: Known knowns and known unknowns. World J Transplant 2025; 15(4): 104675 [DOI: 10.5500/wjt.v15.i4.104675]
Corresponding Author of This Article
Abdul Rahman Hakeem, PhD, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. abdul.hakeem1@nhs.net
Research Domain of This Article
Surgery
Article-Type of This Article
Meta-Analysis
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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/
Dec 18, 2025 (publication date) through Nov 19, 2025
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Publication Name
World Journal of Transplantation
ISSN
2220-3230
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Uragoda Appuhamilage B, Gupta S, Parente A, Srinivasan P, Menon K, Hakeem AR. Systematic review and meta-analysis of the role of aorto-hepatic conduits in liver transplant: Known knowns and known unknowns. World J Transplant 2025; 15(4): 104675 [DOI: 10.5500/wjt.v15.i4.104675]
Buddhika Uragoda Appuhamilage, Sahil Gupta, Alessandro Parente, Parthi Srinivasan, Krishna Menon, Abdul Rahman Hakeem, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom
Author contributions: Hakeem AR and Appuhamilage BU conceptualized the study design; Hakeem AR, Appuhamilage BU and Gupta S prepared the search strategy, PRISMA chart, and data collection tools; Appuhamilage BU and Gupta S did the data collection from the included reviews and performed quality and risk of bias assessments; Appuhamilage BU did the statistical analysis and wrote the manuscript; Gupta S, Parente A, Srinivasan P, Menon K, and Hakeem AR revised the manuscript and confirmed the final draft for submission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdul Rahman Hakeem, PhD, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. abdul.hakeem1@nhs.net
Received: December 29, 2024 Revised: March 24, 2025 Accepted: June 13, 2025 Published online: December 18, 2025 Processing time: 326 Days and 21.1 Hours
Abstract
BACKGROUND
Aorto-hepatic conduits (AHCs) are an effective revascularization method for liver allografts when the native hepatic artery is unusable. Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.
AIM
To investigate the published evidence on the outcomes according to different inflow site for AHCs.
METHODS
A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years (January 2014 onwards). Two independent reviewers selected articles, assessed quality, and evaluated bias in the included systematic reviews. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. The protocol was registered with PROSPERO (CRD42024545810). Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.
RESULTS
Fourteen studies identified a total of 32486 deceased donor liver transplants, of which 1136 (3.5%) required AHCs. The most frequent indications for AHC use included poor arterial flow, intimal dissections, and hepatic artery thrombosis. Among all AHCs, 207 (18.2%) were supra-coeliac (SC) AHCs, 738 (65.0%) infra-renal (IR) AHCs, 25 (2.2%) iliac artery conduits, and 166 (14.6%) had unspecified origins. Pooled analysis revealed comparable demographic characteristics. The median follow-up duration ranged from 18 to 52 months. There were no significant differences in early occlusions of AHCs [odds ratio (OR) = 0.94 (0.48, 1.84); P = 0.86], late occlusions of AHCs [OR = 0.46 (0.16, 1.32); P = 0.15], early allograft dysfunction [OR = 0.82 (0.46, 1.47); P = 0.51], biliary complications [OR = 1.10 (0.69, 1.76); P = 0.68], post-transplant renal replacement therapy (RRT) requirement [OR = 1.12 (0.72, 1.72); P = 0.62], and major surgical complications (Clavien-Dindo > 3b) [OR = 1.06 (0.70, 1.61); P = 0.79]. The median duration for graft occlusion was approximately 142 days, ranging from 13 to 3313 days. One-year graft and patient survival rates for SC conduits were 77% to 81.1% and 80% to 85.1%, respectively. For IR conduits, one-year graft and patient survival rates were 66% to 79.1% and 73% to 88.3%, respectively. Five-year graft and patient survival rates for SC conduits were 53.9% to 67% and 67.8% to 74%, respectively. For IR conduits, five-year graft and patient survival rates were 50% to 56% and 56% to 64.9%, respectively.
CONCLUSION
Considering these findings, there is no significant difference in early and late outcomes between SC and IR AHCs, although there is a discernible tendency towards higher late occlusion rates in the IR group.
Core Tip: This meta-analysis of fourteen studies identified aorta-hepatic conduits utilized in 3.5% of deceased donor liver transplantation, with the majority being infra-renal conduits, however, 5-year patency was better with supra-coeliac aortic conduits.
