Impact of Microsurgical Anastomosis of Hepatic Artery on Arterial Complications and Survival Outcomes After Liver Transplantation

Hepatic artery (HA) complications after liver transplant (LT) can lead to biliary complications, graft failure, and mortality. Although microsurgery has been established to improve anastomotic outcomes, it prolongs surgical time and has not reached widespread adoption at all transplant centers. We i...

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Veröffentlicht in:Transplantation proceedings 2021-01, Vol.53 (1), p.65-72
Hauptverfasser: Tan, Ek Khoon, Tan, Bien Keem, Fong, Hui Chai, Chua, Deborah, Chew, Khong Yik, Koh, Ye Xin, Chung, Alexander Yaw-Fui, Lee, Ser Yee, Teo, Jin Yao, Cheow, Peng Chung, Chan, Chung Yip, Goh, Brian Kim-Poh, Jeyaraj, Prema Raj
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container_issue 1
container_start_page 65
container_title Transplantation proceedings
container_volume 53
creator Tan, Ek Khoon
Tan, Bien Keem
Fong, Hui Chai
Chua, Deborah
Chew, Khong Yik
Koh, Ye Xin
Chung, Alexander Yaw-Fui
Lee, Ser Yee
Teo, Jin Yao
Cheow, Peng Chung
Chan, Chung Yip
Goh, Brian Kim-Poh
Jeyaraj, Prema Raj
description Hepatic artery (HA) complications after liver transplant (LT) can lead to biliary complications, graft failure, and mortality. Although microsurgery has been established to improve anastomotic outcomes, it prolongs surgical time and has not reached widespread adoption at all transplant centers. We investigated the incidences of arterial, biliary complications and outcomes after using microsurgery to anastomose HA during LT. Retrospective cohort of consecutive LT performed from 2006 to 2018 was reviewed for operative details and postoperative outcomes. Cox-regression models were used to investigate the relationship between variables and outcomes. Eighty (62.5%) LTs (Group 1) were performed without and compared with 48 (Group 2) with microsurgical anastomosis of HA. Both groups were comparable in terms of arterial and biliary anastomoses performed. Incidence of early HA thrombosis was similar (6.2% vs 2.1%, P = .28). Group 2 had lower incidence of short- and long-term arterial complications, especially amongst living donor liver transplantations (LDLT) (5.3% vs 35.0%, P = .022). On multivariate analysis, microsurgery was associated with lower risk (hazard ratio [HR] 0.09, 95% confidence interval [CI] 0.01-0.71) of, and LDLT had higher risk (HR 4.23, 95% CI 1.46-12.27) of arterial complications. Biliary complications were associated with LDLT (HR 3.91, 95% CI 1.30-11.71) and dual biliary anastomoses (HR 5.26, 95% CI 1.15-24.08) but not with occurrence of HA complications. Worse patient survival was associated with the occurrence of any HA complication (HR 4.11, 95% CI 1.78-9.48). Hepatic arterial complications can be reduced using microsurgical techniques for the anastomosis, resulting in improved patient survival outcomes after liver transplantation. •Hepatic arterial complications (both early and late) increase the risk of death after liver transplant.•Microsurgical reconstruction of hepatic artery reduces the risk of any arterial complication, particularly in LDLT.•In low-volume transplant centers, performing microscopic reconstruction of hepatic artery in DDLT can allow rapid familiarization of the setup in preparation for LDLT.
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Although microsurgery has been established to improve anastomotic outcomes, it prolongs surgical time and has not reached widespread adoption at all transplant centers. We investigated the incidences of arterial, biliary complications and outcomes after using microsurgery to anastomose HA during LT. Retrospective cohort of consecutive LT performed from 2006 to 2018 was reviewed for operative details and postoperative outcomes. Cox-regression models were used to investigate the relationship between variables and outcomes. Eighty (62.5%) LTs (Group 1) were performed without and compared with 48 (Group 2) with microsurgical anastomosis of HA. Both groups were comparable in terms of arterial and biliary anastomoses performed. Incidence of early HA thrombosis was similar (6.2% vs 2.1%, P = .28). Group 2 had lower incidence of short- and long-term arterial complications, especially amongst living donor liver transplantations (LDLT) (5.3% vs 35.0%, P = .022). On multivariate analysis, microsurgery was associated with lower risk (hazard ratio [HR] 0.09, 95% confidence interval [CI] 0.01-0.71) of, and LDLT had higher risk (HR 4.23, 95% CI 1.46-12.27) of arterial complications. Biliary complications were associated with LDLT (HR 3.91, 95% CI 1.30-11.71) and dual biliary anastomoses (HR 5.26, 95% CI 1.15-24.08) but not with occurrence of HA complications. Worse patient survival was associated with the occurrence of any HA complication (HR 4.11, 95% CI 1.78-9.48). Hepatic arterial complications can be reduced using microsurgical techniques for the anastomosis, resulting in improved patient survival outcomes after liver transplantation. •Hepatic arterial complications (both early and late) increase the risk of death after liver transplant.•Microsurgical reconstruction of hepatic artery reduces the risk of any arterial complication, particularly in LDLT.•In low-volume transplant centers, performing microscopic reconstruction of hepatic artery in DDLT can allow rapid familiarization of the setup in preparation for LDLT.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2020.08.017</identifier><identifier>PMID: 32951861</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>Adult ; Anastomosis, Surgical - adverse effects ; Anastomosis, Surgical - methods ; Cohort Studies ; Female ; Hepatic Artery - surgery ; Humans ; Immunology ; Incidence ; Life Sciences &amp; Biomedicine ; Liver Transplantation - adverse effects ; Liver Transplantation - methods ; Living Donors ; Male ; Microsurgery - methods ; Middle Aged ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Reconstructive Surgical Procedures - methods ; Retrospective Studies ; Science &amp; Technology ; Surgery ; Transplantation ; Vascular Surgical Procedures - methods</subject><ispartof>Transplantation proceedings, 2021-01, Vol.53 (1), p.65-72</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. 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Although microsurgery has been established to improve anastomotic outcomes, it prolongs surgical time and has not reached widespread adoption at all transplant centers. We investigated the incidences of arterial, biliary complications and outcomes after using microsurgery to anastomose HA during LT. Retrospective cohort of consecutive LT performed from 2006 to 2018 was reviewed for operative details and postoperative outcomes. Cox-regression models were used to investigate the relationship between variables and outcomes. Eighty (62.5%) LTs (Group 1) were performed without and compared with 48 (Group 2) with microsurgical anastomosis of HA. Both groups were comparable in terms of arterial and biliary anastomoses performed. Incidence of early HA thrombosis was similar (6.2% vs 2.1%, P = .28). Group 2 had lower incidence of short- and long-term arterial complications, especially amongst living donor liver transplantations (LDLT) (5.3% vs 35.0%, P = .022). On multivariate analysis, microsurgery was associated with lower risk (hazard ratio [HR] 0.09, 95% confidence interval [CI] 0.01-0.71) of, and LDLT had higher risk (HR 4.23, 95% CI 1.46-12.27) of arterial complications. Biliary complications were associated with LDLT (HR 3.91, 95% CI 1.30-11.71) and dual biliary anastomoses (HR 5.26, 95% CI 1.15-24.08) but not with occurrence of HA complications. Worse patient survival was associated with the occurrence of any HA complication (HR 4.11, 95% CI 1.78-9.48). Hepatic arterial complications can be reduced using microsurgical techniques for the anastomosis, resulting in improved patient survival outcomes after liver transplantation. •Hepatic arterial complications (both early and late) increase the risk of death after liver transplant.•Microsurgical reconstruction of hepatic artery reduces the risk of any arterial complication, particularly in LDLT.•In low-volume transplant centers, performing microscopic reconstruction of hepatic artery in DDLT can allow rapid familiarization of the setup in preparation for LDLT.</description><subject>Adult</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Anastomosis, Surgical - methods</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Hepatic Artery - surgery</subject><subject>Humans</subject><subject>Immunology</subject><subject>Incidence</subject><subject>Life Sciences &amp; Biomedicine</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver Transplantation - methods</subject><subject>Living Donors</subject><subject>Male</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Retrospective Studies</subject><subject>Science &amp; 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Although microsurgery has been established to improve anastomotic outcomes, it prolongs surgical time and has not reached widespread adoption at all transplant centers. We investigated the incidences of arterial, biliary complications and outcomes after using microsurgery to anastomose HA during LT. Retrospective cohort of consecutive LT performed from 2006 to 2018 was reviewed for operative details and postoperative outcomes. Cox-regression models were used to investigate the relationship between variables and outcomes. Eighty (62.5%) LTs (Group 1) were performed without and compared with 48 (Group 2) with microsurgical anastomosis of HA. Both groups were comparable in terms of arterial and biliary anastomoses performed. Incidence of early HA thrombosis was similar (6.2% vs 2.1%, P = .28). Group 2 had lower incidence of short- and long-term arterial complications, especially amongst living donor liver transplantations (LDLT) (5.3% vs 35.0%, P = .022). On multivariate analysis, microsurgery was associated with lower risk (hazard ratio [HR] 0.09, 95% confidence interval [CI] 0.01-0.71) of, and LDLT had higher risk (HR 4.23, 95% CI 1.46-12.27) of arterial complications. Biliary complications were associated with LDLT (HR 3.91, 95% CI 1.30-11.71) and dual biliary anastomoses (HR 5.26, 95% CI 1.15-24.08) but not with occurrence of HA complications. Worse patient survival was associated with the occurrence of any HA complication (HR 4.11, 95% CI 1.78-9.48). Hepatic arterial complications can be reduced using microsurgical techniques for the anastomosis, resulting in improved patient survival outcomes after liver transplantation. •Hepatic arterial complications (both early and late) increase the risk of death after liver transplant.•Microsurgical reconstruction of hepatic artery reduces the risk of any arterial complication, particularly in LDLT.•In low-volume transplant centers, performing microscopic reconstruction of hepatic artery in DDLT can allow rapid familiarization of the setup in preparation for LDLT.</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>32951861</pmid><doi>10.1016/j.transproceed.2020.08.017</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4130-3131</orcidid><orcidid>https://orcid.org/0000-0002-5949-4741</orcidid></addata></record>
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subjects Adult
Anastomosis, Surgical - adverse effects
Anastomosis, Surgical - methods
Cohort Studies
Female
Hepatic Artery - surgery
Humans
Immunology
Incidence
Life Sciences & Biomedicine
Liver Transplantation - adverse effects
Liver Transplantation - methods
Living Donors
Male
Microsurgery - methods
Middle Aged
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Reconstructive Surgical Procedures - methods
Retrospective Studies
Science & Technology
Surgery
Transplantation
Vascular Surgical Procedures - methods
title Impact of Microsurgical Anastomosis of Hepatic Artery on Arterial Complications and Survival Outcomes After Liver Transplantation
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