Dunbar Syndrome in Liver Transplantation: Results of a Single Center Matched-Pair Analysis and a European Survey Study

D. Morales-Santana,¹ Z. Czigany,¹ J. Böcker,¹ A. Andert,¹ W. Schöning,¹ T. Ulmer,¹ J. Bednarsch,¹ I. Amygdalos,¹ F. Meister,¹ P. Isfort,³ M. Liebl,³ D. Kroy,² F. Tacke,² C. Trautwein,² U. Neumann,¹ G. Lurje.¹

¹Department of Surgery and Transplantation, University Hospital RWTH, Aachen, Germany
²Department of Internal Medicine III, University Hospital RWTH, Aachen, Germany
³Institute of Radiology, University Hospital RWTH, Aachen, Germany.

Meeting: 2018 American Transplant Congress

Abstract number: A253

Keywords: Graft survival, Liver, Retransplantation

Session Information

Session Name: Poster Session A: Liver Retransplantation and Other Complications

Session Type: Poster Session

Date: Saturday, June 2, 2018

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall 4EF

Background: Median-arcuate-ligament or Dunbar-syndrome (MALs) potentially causes arterial complications in orthotopic liver transplantation (OLT). This study aimed to investigate MALs incidence and its impact on outcome after OLT. Additionally, a survey-study was performed within 52 European centers to assess local protocols on managing MALs in OLT.

Methods: Between 2010-2017 MALs was diagnosed in 32 patients at our center (32/302; 10 %). A matched-pair analysis (32:64; based on BAR-score, recipient age, transplant indication) was carried out comparing postoperative complications as assessed by the Clavien-Dindo-Score (CD) and the comprehensive-complication-index (CCI). An online-survey with open-ended multiple-choice questions was sent to 52 European centers. The survey sought information on OLT case-load and the management of patients with MALs. Both qualitative and quantitative methods were used for data-analysis.

Results: Baseline characteristics (demographics, indications, MELD, SOFT, PSOFT, DRI, cold- and warm-ischemic time, distribution of extended criteria grafts) showed no significant differences. Cohen`s Kappa confirmed good inter-observer agreement (k=0.779) on the radiological diagnosis of MALs based on the independent evaluation of two staff radiologists. Incidence of major complications (CD 3 and over), early allograft dysfunction, CCI-scores were not significantly different between the matched groups (p=0.398; 0.767; 0.704, respectively). ICU- and hospital stay showed no significant between group differences (p=0.240; 0.219, respectively). Five-year graft (77% vs. 76%; p=0.839) and patient (81% vs. 80%; p=0.820) survival did not differ significantly between groups. 42/52 (81%) centers gave a valid response to our survey. Strategies regarding management of MALs were heterogeneous. Division of MAL during OLT in cases of Dunbar-syndrome was reported in 29% as routine procedure.

Conclusions: Although, the European approach on handling MALs in OLT is heterogeneous, dividing MAL in Dunbar-syndrome, seems to provide a feasible approach to avoid vascular complications.

CITATION INFORMATION: Morales-Santana D., Czigany Z., Böcker J., Andert A., Schöning W., Ulmer T., Bednarsch J., Amygdalos I., Meister F., Isfort P., Liebl M., Kroy D., Tacke F., Trautwein C., Neumann U., Lurje G. Dunbar Syndrome in Liver Transplantation: Results of a Single Center Matched-Pair Analysis and a European Survey Study Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Morales-Santana D, Czigany Z, Böcker J, Andert A, Schöning W, Ulmer T, Bednarsch J, Amygdalos I, Meister F, Isfort P, Liebl M, Kroy D, Tacke F, Trautwein C, Neumann U, Lurje G. Dunbar Syndrome in Liver Transplantation: Results of a Single Center Matched-Pair Analysis and a European Survey Study [abstract]. https://atcmeetingabstracts.com/abstract/dunbar-syndrome-in-liver-transplantation-results-of-a-single-center-matched-pair-analysis-and-a-european-survey-study/. Accessed May 16, 2025.

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