Systematic review and meta-analysis of the role of aorto-hepatic conduits in liver transplant: Known knowns and known unknowns

Table 1 Risk of bias assessment (Newcastle-Ottawa Scale)

Ref.	Year	Design	Selection	Comparability	Reliability	Total
Hummel et al[11]	2014	Retrospective	4	1	2	7
Livingston et al[18]	2019	Retrospective	4	2	3	9
Vivarelli et al[19]	2020	Retrospective	4	2	3	9
Oberkofler et al[21]	2021	Retrospective	4	2	2	8

Table 2 Demographic characteristics of included studies

Ref.	Year	Country	Study period	Study design	Conduit material	Total No. of LT	Aorto-hepatic conduits	Supra-coeliac/infra-renal	Median follow up (months)
Hummel et al[11]	2014	Germany	2005-2008	Retrospective	IA	114	15	8/7	NA
Denecke et al[12]	2016	Austria	1990-2012	Retrospective	IA	947	43	1/42	NA
Li et al[13]	2017	Taiwan	2002-2015	Retrospective	GSV	NA	11	11/0	NA
Kazemi et al[14]	2017	Iran	2011-2016	Retrospective	IA	2135	76	0/76	NA
Jung et al[15]	2018	Korea	2011-2016	Retrospective	IA	1928	25	0/25	3
Oberkofler et al[16]	2018	Switzerland	2007-2016	Retrospective	IA	361	29	2/27	46
Bhatti et al[17]	2019	Pakistan	2012-2017	Retrospective	GSV	452	19	3/16	18
Livingston et al[18]	2019	United States	2000-2016	Retrospective	IA	3125	104	22/82	52.8
Vivarelli et al[19]	2020	Italy (multicentre)	2003-2018	Retrospective	IA/Axillary	4255	120	64/56	SC: 47.5; IR: 62.5
Devcic et al[20]	2020	USA	2000-2016	Retrospective	IA	3125	104	NA	NA
Oberkofler et al[21]	2021	International multicentre (14 centres)	2007-2016	Retrospective	IA/Prosthetic	11133	565	111/42 (Iliac = 14)	36.5
Beaurepaire et al[8]	2022	France	2002-2017	Retrospective	IA/Prosthetic	1677	68	Iliac artery: SC + IR = 50, Iliac = 6. Prosthesis: SC = 1, IR = 6, Iliac = 5	61
Bhatti et al[22]	2023	Pakistan	2017-2020	Retrospective	GSV	498	14	4/10	34.9
Sohrabi et al[23]	2024	Iran	2009-2020	Retrospective	IA	4010	16	0/16	35

GSV: Great saphenous vein; IA: Iliac artery; IR: Infra-renal; LT: Liver transplant; SC: Supra-coeliac.

Table 3 Recipient characteristics of studies included for meta-analysis, n (%)

Ref.	Year	No. of Patients		Recipient age, median (SD)		Recipient gender (male%)		Recipient BMI (kg/m2)		Redo transplant		Indications for Transplant (V-Viral, A- Alcohol, M-MASLD, O-Other, NA-not available)		MELD		Previous TACE
		SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR
Hummel et al[11]	2014	8	7	50.9 (12.2)	46.6 (14.3)	6 (75)	7 (100)	23.5 (3)	27.4 (3.7)	3 (37.5)	3 (42.9)	NA	NA	22.7 (11.7)	16.5(9.5)	NA	NA
Livingston et al[18]	2019	22	82	51.5 (13.3)	52.7 (10.7)	14 (63.6)	57 (69.5)	25.7 (5.5)	26.3 (5.2)	10 (45.5)	45 (54.9)	NA	NA	19.6 (9.7)	19.0 (10.4)	NA	NA
Vivarelli et al[19]	2020	64	56	49.5 (14.4)	49.5 (11.8)	45 (70.3)	41 (73.2)	24.2(3.6)	25.5 (4.9)	16 (25.0)	14 (25.0)	V-32 (50.0%) A-8 (12.5%) M-8 (12.5%) O-3 (4.7%)	V-30 (53.6%) A-6 (10.7%),M-2 (3.6%),O-4 (7.1%)	22.7 (10.7)	18.7 (7.8)	13 (20.3)	12 (21.4)
Oberkofler et al[21]	2021	111	428	52.5 (11.9)	53.2 (4.9)	65 (59.0)	261 (61.0)	25.1(1.4)	25.5 (2.0)	54 (49.0)	147 (34.0)	NA	NA	25.0 (5.2)	22.7 (6.3)	20.0 (20.0)	61 (15.0)

A: Alcohol related liver disease; BMI: Body mass index; IR: Infra-renal; LT: Liver transplant; MASLD: Metabolic-associated steatotic liver disease; MELD: Model for end-stage liver disease; NA: Not available; O: Other aetiology; SC: Supra-coeliac; TACE: Transarterial chemoembolisation; V: Viral aetiology.

Table 4 Details of aorto-hepatic conduits in the included studies, n (%)

Ref.	Year	Number of patients		Early occlusions		Late occlusion		Bile duct complications		Graft survival 1-year		Graft survival 5-year		Patient survival 1-year		Patient survival 5-year
		SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR
Hummel et al[11]	2014	8	7	0	0	0	0	4 (50.0)	3 (42.9)	NA	NA	NA	NA	57.1%	85.7%	NA	NA
Livingston et al[18]	2019	22	82	0	0	0	5	NA	NA	85.1%	79.1%	53.9%	56.0%	85.1%	88.3%	67.8%	64.9%
Vivarelli et al[19]	2020	64	56	4 (6.2)	6 (10.7)	3 (4.7)	11 (19.6)	20 (31.2)	22 (39.3)	77.0%	66.0%	67.0%	50.0%	80.0%	73.0%	74.0%	56.0%
Oberkofler et al[21]	2021	111	428	9 (8.1)	31 (7.2)	9 (8.0)	41 (9.8)	21 (19.0)	61 (14.0)	NA	NA	NA	NA	NA	NA	NA	NA

IR: Infra-renal; NA: Not available; SC: Supra-coeliac.

Table 5 Complications related to aorto-hepatic conduits in the included studies, n (%)

Ref.	Year	No. of AHCs	Total occlusions	Surgical interventions for oocclusions			Endovascular intervensions for occlusions				Success rate of surgery without retransplantation	Success rate of endovascular
				Re-anastomosis	Re-conduit formation	Retransplants	Stent	PTA	Stent/PTA	CDTL
Hummel et al[11]	2014	15	0	0	0	0	0	0	0	0	NA	NA
Livingston et al[18]	2019	104	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Vivarelli et al[19]	2020	120	24 (20.0)	3 (12.5)	NA	8 (33.0)	8 (33.0)		NA	NA	NA	NA
Oberkofler et al[21]	2021	565	96 (17.0)	8 (8.3)	4 (4.2)	22 (23.0)	4 (4.2)	12 (13.0)	7 (7.3)	6 (11.0)	7 (27.0)	18 (82.0)
Sohrabi et al[23]	2024	16	2 (12.5)	0	0	2 (100)	0	0	0	0	NA	NA
Devcic et al[20]	2020	104	7 (6.7.0)	0	0	0	0	7 (100)	0	0	NA	NA

AHCs: Aorto-hepatic conduits.

Table 6 Other complications in patients receiving aorto-hepatic conduits, n (%)

Ref.	Year	Number of patients		Pre-Cr at LT (mg/dL)		Post-Cr maximum (mg/dL)		Post-transplant CRRT		Early allograft dysfunction		Major surgical interventions (Clavien 3b>0)
		SC	IR	SC	IR	SC	IR	SC	IR	SC	IR	SC	IR
Hummel et al[11]	2014	8	7	0.56 (0.33)	0.97 (0.37)	0.8	1.47	NA	NA	0	0	1 (12.5)	1 (14.3)
Livingston et al[18]	2019	22	82	1.15 (0.71)	1.20 (0.72)	1.17 (0.22)	1.2 (0.26)	2 (10.5)	10 (12.2)	4 (18.2)	24 (29.3)	NA	NA
Vivarelli et al[19]	2020	64	56	1.35 (0.79)	1.82 (1.1)	NA	NA	NA	NA	4 (6.2)	6 (10.7)	NA	NA
Oberkofler et al[21]	2021	111	428	NA	NA	NA	NA	35 (32.0)	122 (29.0)	9 (8.1)	31 (7.2)	66 (60.0)	248 (58.0)

IR: Infra-renal; NA: Not available; SC: Supra-coeliac.

Table 7 Summary table aorto-hepatic conduits

Aorto-hepatic conduit details	Number of studies that have reported (n = 14)
Infow sites	14
Conduit material	14
Second party vs third party donor	1
Storage of the conduits	0
Reason for conduit	9
Choice of inflow site	12
Post-operative doppler monitoring	12
Post-operative anticoagulation	9
Early occlusions	8
Late occlusions	8
Endovascular Interventions for occlusions	3
Surgical interventions (revisions/reconduits/retransplants)	4