Retrospective Study
Copyright ©The Author(s) 2024.
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 value
n1560.01040.025100.0
Sex (male)853.3550.01352.00.870
Age (yr)54.06 [27.0-71.0; 12.1]153.20 [10.0-78.0; 20.3]153.72 [10.0-78.0; 15.5]10.895
Body composition0.708
Underweight 16.7110.028.0
Normal 640.0660.01248.0
Overweight 640.0220.0832.0
Obesity 213.3110.0312.0
Liver disease
Etiology0.459
Congenital biliary atresia00.0110.014.0
Non-alcoholic steatohepatitis320.0220.0520.0
Alcoholic320.0220.0520.0
Autoimmunity2426.7330.0728.0
Hepatitis C213.300.028.0
Hepatocellular carcinoma00.0110.014.0
Hemochromatosis16.7110.028.0
Cryptogenic16.700.014.0
Secondary biliary cirrhosis16.700.014.0
Prior primary non-functioning320.000.0312.00.132
CHILD Pugh Score B/C15100.0770.02288.00.024
MELD Score ≥ 20 points 426.7550.0936.00.234
Primary hepatic neoplasia16.7550.0624.00.013
Hepatic encephalopathy746.7660.01352.00.513
Ascites 1386.7660.01976.00.126
Hypertensive gastropathy746.7660.01352.00.513
Upper gastrointestinal bleeding853.3220.01040.00.096
Hepatorenal syndrome213.3110.0312.00.802
Comorbidities
Type 2 diabetes mellitus746.6700.0728.00.011
Hyperlipidemia16.7330.0416.00.119
Arterial hypertension426.7220.0624.00.702
Cardiac failure16.7110.028.00.840
Hemodynamic support213.3110.0312.00.840
Chronic renal insufficiency 16.700.014.00.535
Acute kidney injury320.0110.0416.00.535
Malnourishment 320.0550.0832.00.124
Decreased bone mineral density746.7550.01248.00.427
Pulmonary disease/impairment960.000.0936.00.095
Hypothyroidism 426.7110.0520.00.381
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 value
n1560.01040.025100.0
Collateral portal circulation1387.0770.02080.00.358
Splenomegaly1280.0660.01872.00.378
Perigastric/periesophagic varices747.0550.01248.01.000
Umbilical vein recanalization640.0220.0832.00.402
Paracaval portosystemic shunt17.000.014.01.000
Epiploic shunts213.0110.0312.01.000
Mesenteric varices320.000.0312.00.250
Splenorenal shunts320.0330.0624.00.653
Portal vein thrombosis21386.6330.01664.00.009
Grade I320.000.0312.0
Grade II533.3330.0832.0
Grade III426.700.0415.0
Grade IV17.700.014.0
Preoperative doppler ultrasound
Portal vein velocity (cm/s)111.60 [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)10.59 [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 value
n1560.01040.025100.0
Surgical time (h) 8.60 [7.7-10.90; 3.9]25.6 [4.2-8.82; 2.8]27.2 [6.8-9.5; 4.30]20.004
Arterialization technique 0.130
Supraceliac graft747.0110.0832.0
Infrarenal graft533.0770.01248.0
ARHA17.0110.028.0
Splenic artery00.0110.014.0
AMA213.000.028.0
Thrombectomy3640.0330.0936.00.691
CIT (h)9.87 [4.0-13.8; 2.4]28.81 [4.9-13.7; 2.7]29.4 [4.0-13.8; 1.5]20.322
CIT > 10 h640.0330.0936.00.691
WIT (min)43.33 [22.0-8.0; 13.8]240.50 [24.0-65.0; 12.6]242.2 [22.0-78.0; 12.8]20.6
WIT > 45 (min) 5330.0832.01
PRBCs (Units)12.00 [6.7-18.0; 13.0]14.50 [1.8-12.8; 1]110.0 [6.4-14.2; 12.0]10.160
Plasma (Units)18.00 [12.2-3.1;15.0]112.00 [8.9-16.5; 8.3]112.0 [12.2-22.1; 13.0]10.414
Cryoprecipitates (Units)22.00 [14.0-3.6;1]120.00 [7.0-21.4; 20.3]120.0 [13.5-3.0; 17.5]10.103
Platelets (Units)12.00 [4.6-4.1; 24.0]19.0 [0.0-30.7; 17.0]112.0 [7.6-3.1; 27.0]10.311
PVA after LT 00.0440.0416.00.170
Table 4 30-d Postoperative outcomes according portal vein arterialization timing
Postoperative events
Pre-reperfusion PVA
%
Post-reperfusion PVA
%
Overall
%
P value
n1560.01040.025100.0
ICU LOS (d)13.00 [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)110.00 [0.0-48.0; 17.0]10.50 [5.5-17.8; 11.7]10.00 [3.8-33.0; 13.5]0.849
Hemoperitoneum16.7110.028.01.000
Bowel resection320.000.0312.00.250
Upper gastrointestinal bleeding320.0330.0624.00.653
Infection746.7770.01456.00.414
Ascites320.0330.0624.00.653
Pleural effusion 320.0220.0520.01.000
Pulmonary complications640.0220.0832.00.402
Encephalopathy 426.7660.01040.00.122
Postoperative atrial fibrillation 16.7110.028.01.000
Congestive cardiac failure 16.7110.028.01.000
Acute kidney injury746.7660.01352.00.688
Hemodialysis requirement320.0330.0624.00.653
Reintervention426.7330.0728.01.000
Postoperative PVA closure 640.0330.0936.00.691
PGD320.0660.0936.00.041
PNF16.7440.0520.00.121
Retransplantation 16.7220.0312.00.543
30-d mortality426.7550.0936.00.397
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)Overall14.00 [11.7-19.0; 10.45]71.00 [58.4-102.8; 68]52.70 [41.24-89.23; 73.50]
No PVT17.00 [13.25-25.98; 12.5]88.00 [60.68-116.50; 45]36.80 [13.89-80.699; 79.10]
PVT11.80 [8.58-17.50; 8.48]48.00 [43.09-109.25; 55.91]60.35 [41.21-109.44; 81.40]
P value10.0370.1690.276
No SPSS14.00 [7.31-23.40; 12.8]84.50 [61.62-121.41; 78.4]75.20 [46.13-109.15; 77.00]
SPSS13.50 [11.02-19.82; 9.95]67.00 [37.51-106.15; 19.16]25.50 [5.32-87.93; 64.60]
P value10.3380.1150.080
No PGD11.80 [8.52-18.63; 8.98]85.82 [64.73-127.48; 80.55]73.42 [48.78-115.95; 86.00]
PGD15.00 [12.53-24.20; 8.6]46.00 [31.05-75.25; 49.25]25.00 [9.78-59.78; 65.50]
P value10.8900.5700.037
Portal vein flow (L/min)Overall0.59 [0.47-0.73; 0.56]3.6 [2.69-4.99; 4.55]3.21 [2.09-4.40; 4.24]
No PVT0.87 [0.41-1.02; 0.82]2.68 [3.29-6.04; 3.05]1.52 [0.65-4.17; 3.22]
PVT0.55 [0.40-0.67; 0.47]2.05 [1.68-5.07; 4.4]3.35 [2.10-5.31; 4.76]
P value10.1870.0650.419
No SPSS0.9 [0.73-1.34; 0.32]2.68 [2.41-5.40; 4.17]1.77 [1.64-4.63; 3.88]
SPSS0.51 [0.38-0.66; 0.5]3.97 [1.58-5.30; 8.65]3.26 [1.19-5.59; 5.50]
P value10.0020.7230.849
No PGD0.75 [0.50-0.82; 0.36]3.95 [2.96-6.07; 4.73]3.34 [2.29-5.42; 4.54]
PGD0.30 [0.24-0.74; 0.51]2.20 [0.93-4.33; 3.1]1.31 [0.41-3.88; 3.09]
P value10.6770.1690.136