Impact of arterial reconstruction type on early ischemic-type biliary lesion after liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yongkun ¹ , ZHANG Bo ² , Lü Tao ¹ , WEI Lai ² , XU Xi ¹ , YAN Lünan ¹ , JIANG Li ¹ , YANG Jian ¹ , XU Gang ¹ , SONG Jiulin ¹ ,  CHEN Zhishui ² ,  YANG Jiayin ¹

1. Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P. R. China;

Corresponding?author：

CHEN Zhishui, Email: zschen@tjh.tjmu.edu.cn; YANG Jiayin, Email: doctoryjy@scu.edu.cn

Keywords：

hepatic artery reconstruction; liver transplantation; ischemic-type biliary lesion

DOI：

10.7507/1007-9424.202202021

Video：

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Objective To investigate the effect of recipient hepatic artery reconstruction site selection on early ischemic-type biliary lesion (ITBL) after liver transplantation. Methods The clinical data of 656 cadaver liver transplantation were collected retrospectively from January 2015 to January 2020 in the Liver Transplantation Center of West China Hospital of Sichuan University and the Institute of Organ Transplantation of Tongji Hospital Affiliated to Huazhong University of Science and Technology. Patients were divided into two groups according to the reconstruction sites of recipient arteries. The distal group was anastomosed at left hepatic artery, right hepatic artery or proper hepatic artery. The proximal group was anastomosed at the gastroduodenal artery, the common hepatic artery or the common hepatic artery-gastroduodenal artery bifurcation. To investigate the differences in the incidence of early postoperative complications between the two groups and the factors influencing the development of ITBL within one year after transplantation. Results Of 656 patients, 262 were in the distal group and 394 were in the proximal group. The incidence of hepatic artery thrombosis was lower in the proximal group than that in the distal group (χ2=5.675, P=0.017), while the differences in the incidences of ITBL-related graft failure and rejection-related graft failure were not statistically significant when compared (all P>0.05). Multivariate logistic regression results showed that hepatic artery thrombosis [OR=4.453, 95%CI (1.318, 15.050), P=0.016] and cold ischemia time >6 h [OR=1.844, 95%CI (1.014, 3.353), P=0.045] were risk factors for early postoperative ITBL in the liver transplant patients, while different hepatic artery reconstruction categories were not risk factors for ITBL [OR=1.166, 95% CI (0.630, 2.157), P=0.625]. Conclusion Hepatic artery anastomosis reconstruction with the recipient common hepatic artery, gastroduodenal artery, and Carrel flap at the common hepatic artery-gastroduodenal artery bifurcation can somewhat reduce the difficulty of anastomosis and does not increase the risk of postoperative ITBL.

Citation： LI Yongkun, ZHANG Bo, Lü Tao, WEI Lai, XU Xi, YAN Lünan, JIANG Li, YANG Jian, XU Gang, SONG Jiulin, CHEN Zhishui, YANG Jiayin. Impact of arterial reconstruction type on early ischemic-type biliary lesion after liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1296-1302. doi: 10.7507/1007-9424.202202021 Copy

1.	Magro B, Tacelli M, Mazzola A, et al. Biliary complications after liver transplantation: current perspectives and future strategies. Hepatobiliary Surg Nutr, 2021, 10(1): 76-92.
2.	Mourad MM, Algarni A, Liossis C, et al. Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation. World J Gastroenterol, 2014, 20(20): 6159-6169.
3.	Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl, 2008, 14(6): 759-769.
4.	Lee JH, Oh DY, Seo JW, et al. Versatility of right gastroepiploic and gastroduodenal arteries for arterial reconstruction in adult living donor liver transplantation. Transplant Proc, 2011, 43(5): 1716-1719.
5.	Fonseca-Neto OCLD, Lima HCS, Rabelo P, et al. Anatomic variations of hepatic artery: a study in 479 liver transplantations. Arq Bras Cir Dig, 2017, 30(1): 35-37.
6.	Zhang BH, Cai YS, Lyu T, et al. Anatomical and extra-anatomical hepatic artery reconstruction during living donor liver transplantation: is it reasonable to classify this way? Transplantation, 2020, 104(4): e111. doi: 10.1097/TP.0000000000003072.
7.	Frongillo F, Lirosi MC, Nure E, et al. Diagnosis and management of hepatic artery complications after liver transplantation. Transplant Proc, 2015, 47(7): 2150-2155.
8.	肖麗娜, 李驍, 耿沖, 等. 內鏡治療肝移植術后膽道并發癥的療效. 中國普外基礎與臨床雜志, 2020, 27(1): 53-57.
9.	Kochhar G, Parungao JM, Hanouneh IA, et al. Biliary complications following liver transplantation. World J Gastroenterol, 2013, 19(19): 2841-2846.
10.	Roos FJM, Poley JW, Polak WG, et al. Biliary complications after liver transplantation; recent developments in etiology, diagnosis and endoscopic treatment. Best Pract Res Clin Gastroenterol, 2017, 31(2): 227-235.
11.	劉浩, 董家勇, 傅志仁, 等. 冷缺血時間對肝移植術后早期移植物功能及排斥反應的影響. 器官移植, 2020, 11(5): 578-583.
12.	Choi HJ, Kim DG, Kim Y, et al. Clinical course of hepatic artery thrombosis after living donor liver transplantation using the right lobe. Liver Transpl, 2018, 24(11): 1554-1560.
13.	Alim A, Erdogan Y, Dayangac M, et al. Normal primary graft function despite early hepatic artery thrombosis after living-donor liver transplant. Exp Clin Transplant, 2022, 20(3): 293-298.
14.	Ziaziaris WA, Darani A, Holland AJA, et al. Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: effect of microvascular techniques and a customized anticoagulation protocol. Pediatr Transplant, 2017, 21(4): e12917. doi: 10.1111/petr.12917.
15.	Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). Ann Med Surg (Lond), 2016, 8: 28-39.
16.	陳亞進, 彭寶崗, 梁力建, 等. 腹腔鏡膽囊切除術中膽管損傷的調查分析. 中華外科雜志, 2008, 46(24): 1892-1894.
17.	Sun Z, Li G, Ai X, et al. Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: incidence, diagnosis, treatment, outcome and mechanism. Crit Rev Oncol Hematol, 2011, 79(2): 164-174.
18.	Kim HK, Chung YH, Song BC, et al. Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma. J Clin Gastroenterol, 2001, 32(5): 423-427.
19.	?ak?r M, Kü?ükkartallar T, Tekin A, et al. Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation. Ulus Cerrahi Derg, 2014, 31(4): 235-237.
20.	Lattanzi B, Ott P, Rasmussen A, et al. Ischemic damage represents the main risk factor for biliary stricture after liver transplantation: A follow-up study in a Danish population. In Vivo, 2018, 32(6): 1623-1628.
21.	Kim PT, Fernandez H, Gupta A, et al. Low measured hepatic artery flow increases rate of biliary strictures in deceased donor liver transplantation: an age-dependent phenomenon. Transplantation, 2017, 101(2): 332-340.
22.	Kim PT, Saracino G, Jennings L, et al. Ratio of hepatic arterial flow to recipient body weight predicts biliary complications after deceased donor liver transplantation. HPB (Oxford), 2014, 16(12): 1083-1087.
23.	Okahara M, Mori H, Kiyosue H, et al. Arterial supply to the pancreas; variations and cross-sectional anatomy. Abdom Imaging, 2010, 35(2): 134-142.

1. Magro B, Tacelli M, Mazzola A, et al. Biliary complications after liver transplantation: current perspectives and future strategies. Hepatobiliary Surg Nutr, 2021, 10(1): 76-92.
2. Mourad MM, Algarni A, Liossis C, et al. Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation. World J Gastroenterol, 2014, 20(20): 6159-6169.
3. Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl, 2008, 14(6): 759-769.
4. Lee JH, Oh DY, Seo JW, et al. Versatility of right gastroepiploic and gastroduodenal arteries for arterial reconstruction in adult living donor liver transplantation. Transplant Proc, 2011, 43(5): 1716-1719.
5. Fonseca-Neto OCLD, Lima HCS, Rabelo P, et al. Anatomic variations of hepatic artery: a study in 479 liver transplantations. Arq Bras Cir Dig, 2017, 30(1): 35-37.
6. Zhang BH, Cai YS, Lyu T, et al. Anatomical and extra-anatomical hepatic artery reconstruction during living donor liver transplantation: is it reasonable to classify this way? Transplantation, 2020, 104(4): e111. doi: 10.1097/TP.0000000000003072.
7. Frongillo F, Lirosi MC, Nure E, et al. Diagnosis and management of hepatic artery complications after liver transplantation. Transplant Proc, 2015, 47(7): 2150-2155.
8. 肖麗娜, 李驍, 耿沖, 等. 內鏡治療肝移植術后膽道并發癥的療效. 中國普外基礎與臨床雜志, 2020, 27(1): 53-57.
9. Kochhar G, Parungao JM, Hanouneh IA, et al. Biliary complications following liver transplantation. World J Gastroenterol, 2013, 19(19): 2841-2846.
10. Roos FJM, Poley JW, Polak WG, et al. Biliary complications after liver transplantation; recent developments in etiology, diagnosis and endoscopic treatment. Best Pract Res Clin Gastroenterol, 2017, 31(2): 227-235.
11. 劉浩, 董家勇, 傅志仁, 等. 冷缺血時間對肝移植術后早期移植物功能及排斥反應的影響. 器官移植, 2020, 11(5): 578-583.
12. Choi HJ, Kim DG, Kim Y, et al. Clinical course of hepatic artery thrombosis after living donor liver transplantation using the right lobe. Liver Transpl, 2018, 24(11): 1554-1560.
13. Alim A, Erdogan Y, Dayangac M, et al. Normal primary graft function despite early hepatic artery thrombosis after living-donor liver transplant. Exp Clin Transplant, 2022, 20(3): 293-298.
14. Ziaziaris WA, Darani A, Holland AJA, et al. Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: effect of microvascular techniques and a customized anticoagulation protocol. Pediatr Transplant, 2017, 21(4): e12917. doi: 10.1111/petr.12917.
15. Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). Ann Med Surg (Lond), 2016, 8: 28-39.
16. 陳亞進, 彭寶崗, 梁力建, 等. 腹腔鏡膽囊切除術中膽管損傷的調查分析. 中華外科雜志, 2008, 46(24): 1892-1894.
17. Sun Z, Li G, Ai X, et al. Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: incidence, diagnosis, treatment, outcome and mechanism. Crit Rev Oncol Hematol, 2011, 79(2): 164-174.
18. Kim HK, Chung YH, Song BC, et al. Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma. J Clin Gastroenterol, 2001, 32(5): 423-427.
19. ?ak?r M, Kü?ükkartallar T, Tekin A, et al. Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation. Ulus Cerrahi Derg, 2014, 31(4): 235-237.
20. Lattanzi B, Ott P, Rasmussen A, et al. Ischemic damage represents the main risk factor for biliary stricture after liver transplantation: A follow-up study in a Danish population. In Vivo, 2018, 32(6): 1623-1628.
21. Kim PT, Fernandez H, Gupta A, et al. Low measured hepatic artery flow increases rate of biliary strictures in deceased donor liver transplantation: an age-dependent phenomenon. Transplantation, 2017, 101(2): 332-340.
22. Kim PT, Saracino G, Jennings L, et al. Ratio of hepatic arterial flow to recipient body weight predicts biliary complications after deceased donor liver transplantation. HPB (Oxford), 2014, 16(12): 1083-1087.
23. Okahara M, Mori H, Kiyosue H, et al. Arterial supply to the pancreas; variations and cross-sectional anatomy. Abdom Imaging, 2010, 35(2): 134-142.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Impact of arterial reconstruction type on early ischemic-type biliary lesion after liver transplantation

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