The Initial Hepatic Artery Reperfusion versus Initial Portal Reperfusion in Liver Transplantation: Where Do We Stand?
1Surgery, University of Virginia Health System, Charlottesville, VA
2School of Medicine, University of Virginia Health System, Charlottesville, VA
3Surgery, University of Pennsylvania Medical Center, Philadelphia, PA.
Meeting: 2018 American Transplant Congress
Abstract number: A239
Keywords: Hepatic artery, Liver grafts, Liver transplantation, Surgical complications
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
Introduction: While initial portal vein reperfusion (PVRP) of a liver allograft is nearly standardized, limited data suggests initial hepatic arterial reperfusion (HARP) may improve hemodynamics and post-transplant outcomes.
Materials and Methods: We retrospectively reviewed consecutive, adult, primary orthotopic liver transplants (OLT) performed between January 2011 and February 2015 at our center. Demographics and outcomes of liver recipients with initial HARP were compared to those with initial PVRP. Results: Of 204 recipients, 53 (26%) were initially perfused from the hepatic artery and 151(74%) were initially perfused from the portal vein. The two groups did not differ in terms of age, gender, MELD score, or type of hepatic artery, portal vein, caval or biliary reconstruction. When comparing recipients with initial HARP vs. PVRP at 3 months and 1 year, there was no difference in the incidence of acute rejection (1.9% vs. 7.9% p=ns, and 7.5% vs. 10.6%, p=ns), hepatic artery thrombosis (1.9% vs. 4.0%, p=ns and 1.9% vs. 7.3%, p=ns), biliary leakage (7.5% vs. 4.0%, p=ns; 9.4 vs. 6.6, p=ns), biliary strictures (7.5% vs. 5.3%; p=ns, 11.3% vs. 7.9%, p=ns) or portal or hepatic venous thrombosis/stenosis (5.7% vs. 5.3%, p=ns; 7.5% vs. 7.9%, p=ns). Furthermore, recipients with initial HARP and PVRP were both hospitalized for a median of 8.5 days (interquartile range [IQR], 6.5 to 15.5 vs. 7.0 to 14.0 days, respectively) and were both in the ICU for a median of 3 days (IQR: 2 to 7 vs. 2 to 4 days, respectively). Initial HARP was associated with significantly less intraoperative PRBC transfusion (median, 11.9 units; IQR, 11.1 to 13.1 units vs. 15.5 units; IQR, 12.9 to 17.9 units, p<0.001). The two groups did not differ in terms of patient and graft survival.
Conclusion: Initial reperfusion of liver allografts with arterial, rather than portal, blood has benefits to hemodynamic stability, did not have deleterious effects on outcomes, and resulted in less intraoperative blood utilization.
CITATION INFORMATION: Shahbazov R., Azari F., Alejo J., Talanian M., Fox M., Kennedy K., Kessel S., Nickkholgh A., Maluf D., Pelletier S. The Initial Hepatic Artery Reperfusion versus Initial Portal Reperfusion in Liver Transplantation: Where Do We Stand? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Shahbazov R, Azari F, Alejo J, Talanian M, Fox M, Kennedy K, Kessel S, Nickkholgh A, Maluf D, Pelletier S. The Initial Hepatic Artery Reperfusion versus Initial Portal Reperfusion in Liver Transplantation: Where Do We Stand? [abstract]. https://atcmeetingabstracts.com/abstract/the-initial-hepatic-artery-reperfusion-versus-initial-portal-reperfusion-in-liver-transplantation-where-do-we-stand/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress