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 |
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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. |
doi_str_mv | 10.1016/j.transproceed.2020.08.017 |
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•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 & 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</subject><ispartof>Transplantation proceedings, 2021-01, Vol.53 (1), p.65-72</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>8</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000648560100009</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c446t-6ab0ca8f6e8fc137a0621ef4d044beeeeaefa30a1bd5fb12b101dff41786b1963</citedby><cites>FETCH-LOGICAL-c446t-6ab0ca8f6e8fc137a0621ef4d044beeeeaefa30a1bd5fb12b101dff41786b1963</cites><orcidid>0000-0003-4130-3131 ; 0000-0002-5949-4741</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.transproceed.2020.08.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,39263,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32951861$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tan, Ek Khoon</creatorcontrib><creatorcontrib>Tan, Bien Keem</creatorcontrib><creatorcontrib>Fong, Hui Chai</creatorcontrib><creatorcontrib>Chua, Deborah</creatorcontrib><creatorcontrib>Chew, Khong Yik</creatorcontrib><creatorcontrib>Koh, Ye Xin</creatorcontrib><creatorcontrib>Chung, Alexander Yaw-Fui</creatorcontrib><creatorcontrib>Lee, Ser Yee</creatorcontrib><creatorcontrib>Teo, Jin Yao</creatorcontrib><creatorcontrib>Cheow, Peng Chung</creatorcontrib><creatorcontrib>Chan, Chung Yip</creatorcontrib><creatorcontrib>Goh, Brian Kim-Poh</creatorcontrib><creatorcontrib>Jeyaraj, Prema Raj</creatorcontrib><title>Impact of Microsurgical Anastomosis of Hepatic Artery on Arterial Complications and Survival Outcomes After Liver Transplantation</title><title>Transplantation proceedings</title><addtitle>TRANSPL P</addtitle><addtitle>Transplant Proc</addtitle><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.</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 & 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 & Technology</subject><subject>Surgery</subject><subject>Transplantation</subject><subject>Vascular Surgical Procedures - methods</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkc1u1DAUhS0EokPhFVDECgkl2InH8bAbhZZWGtQFZW05zjXyKImD7UzVJW_OnckUsawX9rXud_xzDiEfGC0YZeLzvkhBj3EK3gB0RUlLWlBZUFa_ICsm6yovRVm9JCtKOctZxdcX5E2Me4r7klevyUVVbtZMCrYif26HSZuUeZt9dyb4OIdfzug-2446Jj_46OKxeQOTTs5k25AgPGZ-XCqHZOOHqUdNcn6MmR677MccDu6Arbs5GT9AzLYW4WznDjjfnx7f6zGdJG_JK6v7CO_O6yX5eX1139zku7tvt812lxvORcqFbqnR0gqQ1rCq1lSUDCzvKOct4NBgdUU1a7u1bVnZolWdtZzVUrRsI6pL8nE5F337PUNManDRQI8PAT9HVXK8h1b1Cf2yoEdDYgCrpuAGHR4Vo-oYgdqr_yNQxwgUlQojQPH78z1zO2DvSfrkOQJyAR6g9TYaB6OBfxiGJLhcC8qwopvGLS41fh4TSj89X4r014UGtPXgIKizonMBTFKdd8_50F-hicNb</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Tan, Ek Khoon</creator><creator>Tan, Bien Keem</creator><creator>Fong, Hui Chai</creator><creator>Chua, Deborah</creator><creator>Chew, Khong Yik</creator><creator>Koh, Ye Xin</creator><creator>Chung, Alexander Yaw-Fui</creator><creator>Lee, Ser Yee</creator><creator>Teo, Jin Yao</creator><creator>Cheow, Peng Chung</creator><creator>Chan, Chung Yip</creator><creator>Goh, Brian Kim-Poh</creator><creator>Jeyaraj, Prema Raj</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4130-3131</orcidid><orcidid>https://orcid.org/0000-0002-5949-4741</orcidid></search><sort><creationdate>202101</creationdate><title>Impact of Microsurgical Anastomosis of Hepatic Artery on Arterial Complications and Survival Outcomes After Liver Transplantation</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-6ab0ca8f6e8fc137a0621ef4d044beeeeaefa30a1bd5fb12b101dff41786b1963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Anastomosis, Surgical - methods</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Hepatic Artery - surgery</topic><topic>Humans</topic><topic>Immunology</topic><topic>Incidence</topic><topic>Life Sciences & Biomedicine</topic><topic>Liver Transplantation - adverse effects</topic><topic>Liver Transplantation - methods</topic><topic>Living Donors</topic><topic>Male</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Retrospective Studies</topic><topic>Science & Technology</topic><topic>Surgery</topic><topic>Transplantation</topic><topic>Vascular Surgical Procedures - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tan, Ek Khoon</creatorcontrib><creatorcontrib>Tan, Bien Keem</creatorcontrib><creatorcontrib>Fong, Hui Chai</creatorcontrib><creatorcontrib>Chua, Deborah</creatorcontrib><creatorcontrib>Chew, Khong Yik</creatorcontrib><creatorcontrib>Koh, Ye Xin</creatorcontrib><creatorcontrib>Chung, Alexander Yaw-Fui</creatorcontrib><creatorcontrib>Lee, Ser Yee</creatorcontrib><creatorcontrib>Teo, Jin Yao</creatorcontrib><creatorcontrib>Cheow, Peng Chung</creatorcontrib><creatorcontrib>Chan, Chung Yip</creatorcontrib><creatorcontrib>Goh, Brian Kim-Poh</creatorcontrib><creatorcontrib>Jeyaraj, Prema Raj</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tan, Ek Khoon</au><au>Tan, Bien Keem</au><au>Fong, Hui Chai</au><au>Chua, Deborah</au><au>Chew, Khong Yik</au><au>Koh, Ye Xin</au><au>Chung, Alexander Yaw-Fui</au><au>Lee, Ser Yee</au><au>Teo, Jin Yao</au><au>Cheow, Peng Chung</au><au>Chan, Chung Yip</au><au>Goh, Brian Kim-Poh</au><au>Jeyaraj, Prema Raj</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Microsurgical Anastomosis of Hepatic Artery on Arterial Complications and Survival Outcomes After Liver Transplantation</atitle><jtitle>Transplantation proceedings</jtitle><stitle>TRANSPL P</stitle><addtitle>Transplant Proc</addtitle><date>2021-01</date><risdate>2021</risdate><volume>53</volume><issue>1</issue><spage>65</spage><epage>72</epage><pages>65-72</pages><issn>0041-1345</issn><eissn>1873-2623</eissn><abstract>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.</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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