Liver Transplantation Using Allografts With Hepatic Artery Injury During Procurement: A Propensity Score-Matched Analysis of Outcomes

IF 1.9 4区 医学 Q2 SURGERY
Florence Jeune, Chetana Lim, Éric Savier, Claire Goumard, Fabiano Perdigao, Géraldine Rousseau, Olivier Scatton
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Abstract

Background

Hepatic artery (HA) injury during liver procurement is a significant concern in liver transplantation (LT). This study assessed its frequency and impact in deceased donor LT (DDLT).

Methods

This was a single-center cohort study of adults who underwent DDLT from 2010 to 2019. HA injury was defined as the section or ligation of arterial branches supplying the graft. Recipients, donors’ characteristics and outcomes of LTs using grafts with HA injury (group 1, n = 35) were compared to LTs using grafts without HA injury (group 2, n = 677). A propensity score matching (PSM) was applied. The primary endpoint was 90-day hepatic artery thrombosis (HAT); secondary endpoints included major biliary complications, retransplantation, patient, and graft-survival.

Results

HA injury occurred in 4.9% of grafts. Aberrant HA anatomy was an independent predictive factor of HA injury (OR = 8.1 [3.7–17.9], p < 0.0001). Arterial reconstruction was required in 53.8% of injured grafts, while 23% had lateral sutures and 23% required no reconstruction. Arterial ischemia time was longer in group 1 (50 min [42–67] vs. 43 min [35–56]; p = 0.007). At 90-day, HAT (2.9% vs. 0.7%; p = 0.26), major biliary complications (5.7% vs. 7.2%, p>0.99) and retransplantation rates (2.9 % vs. 1%, p = 0.33) were similar. After PSM, theses outcomes remained comparable. The 5-year patient (74.3% vs. 78.3 %, p = 0.77) and graft-survival (70.2% vs. 75.6%, p = 0.78) were also similar.

Conclusion

HA injury during procurement was rare and did not impact mid- or long-term LT outcomes, supporting a “non-restrictive graft policy” regarding grafts with HA injury.

Abstract Image

肝动脉损伤的同种异体肝移植:倾向评分匹配结果分析。
背景:肝获取过程中肝动脉(HA)损伤是肝移植(LT)的重要问题。本研究评估了其在已故供体肝移植(DDLT)中的频率和影响。方法:这是一项针对2010年至2019年接受DDLT的成年人的单中心队列研究。HA损伤定义为供血动脉分支的切断或结扎。将HA损伤的肝移植(1组,n = 35)与未HA损伤的肝移植(2组,n = 677)的受体、供体特征和结果进行比较。采用倾向评分匹配(PSM)。主要终点为90天肝动脉血栓形成(HAT);次要终点包括主要胆道并发症、再移植、患者和移植物存活率。结果:4.9%的移植物发生HA损伤。异常血凝素解剖结构是血凝素损伤的独立预测因素(OR = 8.1 [3.7-17.9], p 0.99),再移植率(2.9% vs. 1%, p = 0.33)相似。在PSM后,这些结果仍然具有可比性。5年患者(74.3% vs. 78.3%, p = 0.77)和移植物存活率(70.2% vs. 75.6%, p = 0.78)也相似。结论:在移植过程中HA损伤是罕见的,并且不影响中期或长期的移植结果,支持对于HA损伤的移植物的“非限制性移植物政策”。
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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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