Donor Atheromatous Disease is a Risk Factor for Hepatic Artery Thrombosis After Liver Transplantation

IF 1.9 4区 医学 Q2 SURGERY
Javier M. Zamora-Olaya, Rocío Tejero-Jurado, Paloma E. Alañón-Martínez, María Prieto-Torre, Cristina Rodríguez-Medina, José L. Montero, Marina Sánchez-Frías, Javier Briceño, Rubén Ciria, Pilar Barrera, Antonio Poyato, Manuel De la Mata, Manuel L. Rodríguez-Perálvarez
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Abstract

The increasing age of liver donors and transplant candidates, together with the growing prevalence of metabolic comorbidities, could impact the risk of vascular complications after liver transplantation. We enrolled a consecutive cohort of adult patients undergoing liver transplantation from 2012 to 2021 who had a blinded pathological assessment of atherosclerosis in the donor and recipient hepatic arteries (HA). Patients receiving partial or reduced grafts, retransplantation, or combined organ transplantation were excluded. The relationship between HA atherosclerosis and HA thrombosis after liver transplantation was evaluated using logistic regression in the whole study cohort and in a propensity score-matched subpopulation. Among 443 eligible patients, 272 had a full pathological evaluation of the donor and recipient HA and were included in the study. HA atheroma was present in 51.5% of donors and in 11.4% of recipients. HA thrombosis occurred in 16 patients (5.9%), being more likely in patients who received a donor with HA atherosclerosis than in those without (10.7% vs. 0.8%; p < 0.001). Donor HA atherosclerosis was an independent risk factor of HA thrombosis (OR = 17.79; p = 0.008), and this finding was consistent in the propensity score-matched analysis according to age, sex, complex arterial anastomosis, and alcoholic liver disease (OR = 19.29; p = 0.007). Atheromatous disease in the recipient had no influence on the risk of HA thrombosis (OR = 1.70; p = 0.55). In conclusion, patients receiving donors with HA atherosclerosis are at increased risk for HA thrombosis after liver transplantation. The evaluation of the donor graft vasculature could guide antiplatelet therapy in the postoperative period.

Abstract Image

供体动脉粥样硬化症是肝移植后肝动脉血栓形成的风险因素之一
肝脏捐献者和移植候选者的年龄不断增长,加上代谢性合并症的发病率越来越高,这可能会影响肝脏移植后血管并发症的风险。我们从2012年到2021年连续招募了一批接受肝移植的成年患者,对供体和受体肝动脉(HA)的动脉粥样硬化进行了盲法病理评估。接受部分或缩小移植、再次移植或联合器官移植的患者不包括在内。在整个研究队列和倾向评分匹配亚群中,采用逻辑回归法评估了肝移植后肝动脉粥样硬化与肝血栓形成之间的关系。在 443 名符合条件的患者中,有 272 人对供体和受体的 HA 进行了全面的病理评估,并被纳入研究。51.5%的供体和11.4%的受体存在HA粥样斑块。16名患者(5.9%)发生了HA血栓,与没有HA动脉粥样硬化的患者相比,接受有HA动脉粥样硬化的供体的患者更容易发生血栓(10.7% vs. 0.8%;P<0.05)。
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来源期刊
Clinical Transplantation
Clinical Transplantation 医学-外科
CiteScore
3.70
自引率
4.80%
发文量
286
审稿时长
2 months
期刊介绍: Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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