How to Handle Arterial Conduits in Liver Transplantation? Evidence From the First Multicenter Risk Analysis.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
24
1
2020
medline:
15
12
2021
entrez:
24
1
2020
Statut:
ppublish
Résumé
The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective. Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature. This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2007 to December 2016. Primary endpoint was arterial occlusion/patency. Secondary endpoints included intra- and perioperative outcomes and graft and patient survival. The cohort was composed of 565 LT. Infrarenal aortic placement was performed in 77% of ACs whereas supraceliac placement in 20%. Early occlusion (≤30 days) occurred in 8% of cases. Primary patency was equivalent for supraceliac, infrarenal, and iliac conduits. Multivariate analysis identified donor age >40 years, coronary artery bypass, and no aspirin after LT as independent risk factors for early occlusion. Postoperative antiaggregation regimen differed among centers and was given in 49% of cases. Graft survival was significantly superior for patients receiving aggregation inhibitors after LT. When AC is required for rescue graft revascularization, the conduit placement site seems to be negligible and should follow the surgeon's preference. In this high-risk group, the study supports the concept of postoperative antiaggregation in LT requiring AC.
Sections du résumé
OBJECTIVE
The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective.
BACKGROUND
Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature.
STUDY DESIGN
This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2007 to December 2016. Primary endpoint was arterial occlusion/patency. Secondary endpoints included intra- and perioperative outcomes and graft and patient survival.
RESULTS
The cohort was composed of 565 LT. Infrarenal aortic placement was performed in 77% of ACs whereas supraceliac placement in 20%. Early occlusion (≤30 days) occurred in 8% of cases. Primary patency was equivalent for supraceliac, infrarenal, and iliac conduits. Multivariate analysis identified donor age >40 years, coronary artery bypass, and no aspirin after LT as independent risk factors for early occlusion. Postoperative antiaggregation regimen differed among centers and was given in 49% of cases. Graft survival was significantly superior for patients receiving aggregation inhibitors after LT.
CONCLUSION
When AC is required for rescue graft revascularization, the conduit placement site seems to be negligible and should follow the surgeon's preference. In this high-risk group, the study supports the concept of postoperative antiaggregation in LT requiring AC.
Identifiants
pubmed: 31972653
pii: 00000658-202112000-00023
doi: 10.1097/SLA.0000000000003753
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1032-1042Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Shaw BW Jr, Iwatsuki S, Starzl TE. Alternative methods of arterialization of the hepatic graft. Surg Gynecol Obstet 1984; 159:490–493.
Reese T, Raptis DA, Oberkofler CE, et al. A systematic review and meta-analysis of rescue revascularization with arterial conduits in liver transplantation. Am J Transplant 2019; 19:551–563.
Chatzizacharias NA, Aly M, Praseedom RK. The role of arterial conduits for revascularisation in adult orthotopic liver transplantation. Transplant Rev (Orlando) 2017; 31:121–126.
Duffy JP, Hong JC, Farmer DG, et al. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg 2009; 208:896–903. discussion 903–905.
Oh CK, Pelletier SJ, Sawyer RG, et al. Uni- and multi-variate analysis of risk factors for early and late hepatic artery thrombosis after liver transplantation. Transplantation 2001; 71:767–772.
Del Gaudio M, Grazi GL, Ercolani G, et al. Outcome of hepatic artery reconstruction in liver transplantation with an iliac arterial interposition graft. Clin Transplant 2005; 19:399–405.
Oberkofler CE, Reese T, Raptis DA, et al. Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease? Liver Transpl 2018; 24:790–802.
Raptis DA, Mettler T, Fischer MA, et al. Managing multicentre clinical trials with open source. Inform Health Soc Care 2014; 39:67–80.
Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002; 35:603–610.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.
Reilly HM, Martineau JK, Moran A, et al. Nutritional screening--evaluation and implementation of a simple nutrition risk score. Clin Nutr 1995; 14:269–273.
Kazemi K, Samidoost P, Deilami HN, et al. A new consideration in hepatic artery reconstruction in adult liver transplant: arterial transposition versus extra-anatomic jump grafts. Exp Clin Transplant 2017; 15: (Suppl 1): 204–207.
Llado L, Ramos E, Bravo A, et al. Short- and long-term outcomes of arterial reconstruction on recipient splenic artery in adult liver transplantation. Single-center prospective study 25 years after first description. Transpl Int 2019; 32:1053–1060.
Frazier OH, Oalmann MC, Strong JP, et al. Clinical applications of the supraceliac aorta: anatomical and pathologic observations. J Thorac Cardiovasc Surg 1987; 93:631–633.
Forbang NI, McClelland RL, Remigio-Baker RA, et al. Associations of cardiovascular disease risk factors with abdominal aortic calcium volume and density: the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis 2016; 255:54–58.
Hummel R, Irmscher S, Schleicher C, et al. Aorto-hepatic bypass in liver transplantation in the MELD-era: outcomes after supraceliac and infrarenal bypasses. Surg Today 2014; 44:626–632.
Muiesan P, Rela M, Nodari F, et al. Use of infrarenal conduits for arterial revascularization in orthotopic liver transplantation. Liver Transpl Surg 1998; 4:232–235.
Stange BJ, Glanemann M, Nuessler NC, et al. Hepatic artery thrombosis after adult liver transplantation. Liver Transpl 2003; 9:612–620.
Herrero A, Souche R, Joly E, et al. Early hepatic artery thrombosis after liver transplantation: what is the impact of the arterial reconstruction type? World J Surg 2017; 41:2101–2110.
Ha H, Lantz J, Ziegler M, et al. Estimating the irreversible pressure drop across a stenosis by quantifying turbulence production using 4D flow MRI. Sci Rep 2017; 7:46618.
Sakariassen KS, Orning L, Turitto VT. The impact of blood shear rate on arterial thrombus formation. Future Sci OA 2015; 1:FSO30.
Vivarelli M, La Barba G, Cucchetti A, et al. Can antiplatelet prophylaxis reduce the incidence of hepatic artery thrombosis after liver transplantation? Liver Transpl 2007; 13:651–654.
Wolf DC, Freni MA, Boccagni P, et al. Low-dose aspirin therapy is associated with few side effects but does not prevent hepatic artery thrombosis in liver transplant recipients. Liver Transpl Surg 1997; 3:598–603.
Shay R, Taber D, Pilch N, et al. Early aspirin therapy may reduce hepatic artery thrombosis in liver transplantation. Transplant Proc 2013; 45:330–334.
Calinescu AM, Karam O, Wilde JCH, et al. International survey on anticoagulation and antiplatelet strategies after pediatric liver transplantation. Pediatr Transplant 2019; 23:e13317.
Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 2016; 134:e123–e155.
Dunning J, Versteegh M, Fabbri A, et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008; 34:73–92.
Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2012; 143:4–34.
Kharbanda RK, Walton B, Allen M, et al. Prevention of inflammation-induced endothelial dysfunction: a novel vasculo-protective action of aspirin. Circulation 2002; 105:2600–2604.
Poujol-Robert A, Boelle PY, Conti F, et al. Aspirin may reduce liver fibrosis progression: evidence from a multicenter retrospective study of recurrent hepatitis C after liver transplantation. Clin Res Hepatol Gastroenterol 2014; 38:570–576.
Simon TG, Ma Y, Ludvigsson JF, et al. Association between aspirin use and risk of hepatocellular carcinoma. JAMA Oncol 2018; 4:1683–1690.
Lee TY, Hsu YC, Tseng HC, et al. Association of daily aspirin therapy with risk of hepatocellular carcinoma in patients with chronic hepatitis B. JAMA Intern Med 2019; 179:633–640.
Lee M, Agostini-Vulaj D, Gonzalez RS. Evaluation of histologic changes in the livers of patients with early and late hepatic artery thrombosis. Hum Pathol 2019; 90:8–13.
Mourad MM, Liossis C, Gunson BK, et al. Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transpl 2014; 20:713–723.
Kogut MJ, Shin DS, Padia SA, et al. Intra-arterial thrombolysis for hepatic artery thrombosis following liver transplantation. J Vasc Interv Radiol 2015; 26:1317–1322.
Orons PD, Sheng R, Zajko AB. Hepatic artery stenosis in liver transplant recipients: prevalence and cholangiographic appearance of associated biliary complications. AJR Am J Roentgenol 1995; 165:1145–1149.
Pulitano C, Joseph D, Sandroussi C, et al. Hepatic artery stenosis after liver transplantation: is endovascular treatment always necessary? Liver Transpl 2015; 21:162–168.
Le L, Terral W, Zea N, et al. Primary stent placement for hepatic artery stenosis after liver transplantation. J Vasc Surg 2015; 62:704–709.
Rajakannu M, Awad S, Ciacio O, et al. Intention-to-treat analysis of percutaneous endovascular treatment of hepatic artery stenosis after orthotopic liver transplantation. Liver Transpl 2016; 22:923–933.
Sarwar A, Chen C, Khwaja K, et al. Primary stent placement for hepatic artery stenosis after liver transplantation: improving primary patency and reintervention rates. Liver Transpl 2018; 24:1377–1383.
Tschuor C, Ferrarese A, Kummerli C, et al. Allocation of liver grafts worldwide is there a best system? J Hepatol 2019; 71:707–718.
Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl 2010; 16:943–949.
Tekin K, Imber CJ, Atli M, et al. A simple scoring system to evaluate the effects of cold ischemia on marginal liver donors. Transplantation 2004; 77:411–416.
Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 1994; 220:50–52.