Retrospective Study
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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2024; 14(2): 92528
Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.92528
Table 1 Recipient characteristics according to the timing of portal vein arterialization
Basic characteristics Pre-reperfusion PVA % Post-reperfusion PVA % Overall % P valuen 15 60.0 10 40.0 25 100.0 Sex (male) 8 53.3 5 50.0 13 52.0 0.870 Age (yr) 54.06 [27.0-71.0; 12.1]1 53.20 [10.0-78.0; 20.3]1 53.72 [10.0-78.0; 15.5]1 0.895 Body composition 0.708 Underweight 1 6.7 1 10.0 2 8.0 Normal 6 40.0 6 60.0 12 48.0 Overweight 6 40.0 2 20.0 8 32.0 Obesity 2 13.3 1 10.0 3 12.0 Liver disease Etiology 0.459 Congenital biliary atresia 0 0.0 1 10.0 1 4.0 Non-alcoholic steatohepatitis 3 20.0 2 20.0 5 20.0 Alcoholic 3 20.0 2 20.0 5 20.0 Autoimmunity2 4 26.7 3 30.0 7 28.0 Hepatitis C 2 13.3 0 0.0 2 8.0 Hepatocellular carcinoma 0 0.0 1 10.0 1 4.0 Hemochromatosis 1 6.7 1 10.0 2 8.0 Cryptogenic 1 6.7 0 0.0 1 4.0 Secondary biliary cirrhosis 1 6.7 0 0.0 1 4.0 Prior primary non-functioning 3 20.0 0 0.0 3 12.0 0.132 CHILD Pugh Score B/C 15 100.0 7 70.0 22 88.0 0.024 MELD Score ≥ 20 points 4 26.7 5 50.0 9 36.0 0.234 Primary hepatic neoplasia 1 6.7 5 50.0 6 24.0 0.013 Hepatic encephalopathy 7 46.7 6 60.0 13 52.0 0.513 Ascites 13 86.7 6 60.0 19 76.0 0.126 Hypertensive gastropathy 7 46.7 6 60.0 13 52.0 0.513 Upper gastrointestinal bleeding 8 53.3 2 20.0 10 40.0 0.096 Hepatorenal syndrome 2 13.3 1 10.0 3 12.0 0.802 Comorbidities Type 2 diabetes mellitus 7 46.67 0 0.0 7 28.0 0.011 Hyperlipidemia 1 6.7 3 30.0 4 16.0 0.119 Arterial hypertension 4 26.7 2 20.0 6 24.0 0.702 Cardiac failure 1 6.7 1 10.0 2 8.0 0.840 Hemodynamic support 2 13.3 1 10.0 3 12.0 0.840 Chronic renal insufficiency 1 6.7 0 0.0 1 4.0 0.535 Acute kidney injury 3 20.0 1 10.0 4 16.0 0.535 Malnourishment 3 20.0 5 50.0 8 32.0 0.124 Decreased bone mineral density 7 46.7 5 50.0 12 48.0 0.427 Pulmonary disease/impairment 9 60.0 0 0.0 9 36.0 0.095 Hypothyroidism 4 26.7 1 10.0 5 20.0 0.381
Table 2 Preoperative portosystemic circulation and portal doppler ultrasound parameters according to timing of portal vein arterialization
Pre-reperfusion PVA % Post-reperfusion PVA % Overall % P valuen 15 60.0 10 40.0 25 100.0 Collateral portal circulation 13 87.0 7 70.0 20 80.0 0.358 Splenomegaly 12 80.0 6 60.0 18 72.0 0.378 Perigastric/periesophagic varices 7 47.0 5 50.0 12 48.0 1.000 Umbilical vein recanalization 6 40.0 2 20.0 8 32.0 0.402 Paracaval portosystemic shunt 1 7.0 0 0.0 1 4.0 1.000 Epiploic shunts 2 13.0 1 10.0 3 12.0 1.000 Mesenteric varices 3 20.0 0 0.0 3 12.0 0.250 Splenorenal shunts 3 20.0 3 30.0 6 24.0 0.653 Portal vein thrombosis2 13 86.6 3 30.0 16 64.0 0.009 Grade I 3 20.0 0 0.0 3 12.0 Grade II 5 33.3 3 30.0 8 32.0 Grade III 4 26.7 0 0.0 4 15.0 Grade IV 1 7.7 0 0.0 1 4.0 Preoperative doppler ultrasound Portal vein velocity (cm/s)1 11.60 [8.30-18.86; 10.8] 16.00 [13.10-23.20; 7.6] 14.00 [11.7-19.0; 10.5] 0.048 Portal vein flow (L/min)1 0.59 [0.40-0.70; 0.23] 0.68 [0.40-0.94; 0.80] 0.59 [0.47-0.73; 0.56] 0.367
Table 3 Surgical variables according to the timing of portal vein arterialization
Intraoperative events Pre-reperfusion PVA % Post-reperfusion PVA % Overall % P valuen 15 60.0 10 40.0 25 100.0 Surgical time (h) 8.60 [7.7-10.90; 3.9]2 5.6 [4.2-8.82; 2.8]2 7.2 [6.8-9.5; 4.30]2 0.004 Arterialization technique 0.130 Supraceliac graft 7 47.0 1 10.0 8 32.0 Infrarenal graft 5 33.0 7 70.0 12 48.0 ARHA 1 7.0 1 10.0 2 8.0 Splenic artery 0 0.0 1 10.0 1 4.0 AMA 2 13.0 0 0.0 2 8.0 Thrombectomy3 6 40.0 3 30.0 9 36.0 0.691 CIT (h) 9.87 [4.0-13.8; 2.4]2 8.81 [4.9-13.7; 2.7]2 9.4 [4.0-13.8; 1.5]2 0.322 CIT > 10 h 6 40.0 3 30.0 9 36.0 0.691 WIT (min) 43.33 [22.0-8.0; 13.8]2 40.50 [24.0-65.0; 12.6]2 42.2 [22.0-78.0; 12.8]2 0.6 WIT > 45 (min) 5 3 30.0 8 32.0 1 PRBCs (Units) 12.00 [6.7-18.0; 13.0]1 4.50 [1.8-12.8; 1]1 10.0 [6.4-14.2; 12.0]1 0.160 Plasma (Units) 18.00 [12.2-3.1;15.0]1 12.00 [8.9-16.5; 8.3]1 12.0 [12.2-22.1; 13.0]1 0.414 Cryoprecipitates (Units) 22.00 [14.0-3.6;1]1 20.00 [7.0-21.4; 20.3]1 20.0 [13.5-3.0; 17.5]1 0.103 Platelets (Units) 12.00 [4.6-4.1; 24.0]1 9.0 [0.0-30.7; 17.0]1 12.0 [7.6-3.1; 27.0]1 0.311 PVA after LT 0 0.0 4 40.0 4 16.0 0.170
Table 4 30-d Postoperative outcomes according portal vein arterialization timing
Postoperative events Pre-reperfusion PVA % Post-reperfusion PVA % Overall % P valuen 15 60.0 10 40.0 25 100.0 ICU LOS (d)1 3.00 [0.0-15.1; 4.0] 3.50 [1.6-4.7; 4.2] 3.00 [1.0-10.6; 4.0] 0.935 LOS (d)1 10.00 [0.0-48.0; 17.0] 10.50 [5.5-17.8; 11.7] 10.00 [3.8-33.0; 13.5] 0.849 Hemoperitoneum 1 6.7 1 10.0 2 8.0 1.000 Bowel resection 3 20.0 0 0.0 3 12.0 0.250 Upper gastrointestinal bleeding 3 20.0 3 30.0 6 24.0 0.653 Infection 7 46.7 7 70.0 14 56.0 0.414 Ascites 3 20.0 3 30.0 6 24.0 0.653 Pleural effusion 3 20.0 2 20.0 5 20.0 1.000 Pulmonary complications 6 40.0 2 20.0 8 32.0 0.402 Encephalopathy 4 26.7 6 60.0 10 40.0 0.122 Postoperative atrial fibrillation 1 6.7 1 10.0 2 8.0 1.000 Congestive cardiac failure 1 6.7 1 10.0 2 8.0 1.000 Acute kidney injury 7 46.7 6 60.0 13 52.0 0.688 Hemodialysis requirement 3 20.0 3 30.0 6 24.0 0.653 Reintervention 4 26.7 3 30.0 7 28.0 1.000 Postoperative PVA closure 6 40.0 3 30.0 9 36.0 0.691 PGD 3 20.0 6 60.0 9 36.0 0.041 PNF 1 6.7 4 40.0 5 20.0 0.121 Retransplantation 1 6.7 2 20.0 3 12.0 0.543 30-d mortality 4 26.7 5 50.0 9 36.0 0.397
Table 5 Comparison of preoperative and postoperative doppler portal ultrasound according to portal vein thrombosis, ligation of spontaneous portosystemic shunts and primary graft dysfunction
Doppler ultrasound parameter Variable Preoperative Postoperative Delta (post-preoperative) Portal vein velocity (cm/s) Overall 14.00 [11.7-19.0; 10.45] 71.00 [58.4-102.8; 68] 52.70 [41.24-89.23; 73.50] No PVT 17.00 [13.25-25.98; 12.5] 88.00 [60.68-116.50; 45] 36.80 [13.89-80.699; 79.10] PVT 11.80 [8.58-17.50; 8.48] 48.00 [43.09-109.25; 55.91] 60.35 [41.21-109.44; 81.40] P value1 0.037 0.169 0.276 No SPSS 14.00 [7.31-23.40; 12.8] 84.50 [61.62-121.41; 78.4] 75.20 [46.13-109.15; 77.00] SPSS 13.50 [11.02-19.82; 9.95] 67.00 [37.51-106.15; 19.16] 25.50 [5.32-87.93; 64.60] P value1 0.338 0.115 0.080 No PGD 11.80 [8.52-18.63; 8.98] 85.82 [64.73-127.48; 80.55] 73.42 [48.78-115.95; 86.00] PGD 15.00 [12.53-24.20; 8.6] 46.00 [31.05-75.25; 49.25] 25.00 [9.78-59.78; 65.50] P value1 0.890 0.570 0.037 Portal vein flow (L/min) Overall 0.59 [0.47-0.73; 0.56] 3.6 [2.69-4.99; 4.55] 3.21 [2.09-4.40; 4.24] No PVT 0.87 [0.41-1.02; 0.82] 2.68 [3.29-6.04; 3.05] 1.52 [0.65-4.17; 3.22] PVT 0.55 [0.40-0.67; 0.47] 2.05 [1.68-5.07; 4.4] 3.35 [2.10-5.31; 4.76] P value1 0.187 0.065 0.419 No SPSS 0.9 [0.73-1.34; 0.32] 2.68 [2.41-5.40; 4.17] 1.77 [1.64-4.63; 3.88] SPSS 0.51 [0.38-0.66; 0.5] 3.97 [1.58-5.30; 8.65] 3.26 [1.19-5.59; 5.50] P value1 0.002 0.723 0.849 No PGD 0.75 [0.50-0.82; 0.36] 3.95 [2.96-6.07; 4.73] 3.34 [2.29-5.42; 4.54] PGD 0.30 [0.24-0.74; 0.51] 2.20 [0.93-4.33; 3.1] 1.31 [0.41-3.88; 3.09] P value1 0.677 0.169 0.136