Background: The use of hepatic artery (HA) and portal vein (PV) conduits is a recognised alternative technique in vessel reconstruction during liver transplantation. The hepatic arterial buffer response (HABR) is an intrinsic mechanism that compensates for changes in PV flow. Whether this mechanism is affected by the use of vascular conduits is unclear. Several centres have reported conflicting results regarding the safety of HA conduits, whereas studies on PV conduits are lacking. This study aims to assess the impact of vascular conduits on intraoperative vascular flows, early allograft dysfunction (EAD), patient and graft survival, and post-operative complications.

Methods: All primary liver transplants and retransplants (n=525) at the Scottish Liver Transplant Unit between January 2009 and December 2014 were retrospectively analysed. Intraoperative flows, transplant outcome and complications rates were compared according to the use of vascular conduits.

Results: There were 51 HA (9.7%) and 13 PV conduits (2.5%). The HA conduit group had a comparable one-year patient and graft survival with the standard reconstruction group, but had a higher incidence of post-transplant hepatic artery thrombosis (HAT) (5.9% vs. 1.3%, P=0.048) and required a longer cold ischaemic time (CIT) (569 minutes vs. 531 minutes, P=0.016). The PV conduit group had a significantly lower one-year patient survival (69.2% vs. 92.2%, P=0.002) and graft survival (61.5% vs. 87.7%, P=0.004) compared with the standard group. The median HA/PV flow ratios were comparable between the HA (0.15 vs. 0.13, P=0.242) and PV conduits (0.14 vs. 01.3,P=0.885), and the respective standard groups. Univariate analysis showed no association between the use of HA [odds ratio (OR) 1.82, P=0.060] and PV conduits (OR 2.39, P=0.161) and development of EAD.

Conclusion: Despite a higher risk of HAT, the use of HA conduits is effective in arterial revascularisation during liver transplant. The placement of PV conduits is associated with inferior patient and graft survival. Current findings also show that a longer CIT in HA reconstruction does not translate into a higher EAD rate.

CITATION INFORMATION: Tan J, Oniscu G. Outcomes of Arterial and Venous Conduits for Vessel Reconstruction in Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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