Interposition of donor iliac graft to revascularization of liver in orthotopic transplantation: Description of 745 transplants sampling performed and literature review

Abstract

Hepatic artery thrombosis is an important complication in liver transplants, remaining a serious cause for graft failure. Treatment involves revascularization performed by endovascular techniques or arterial reconstruction. In cases such as presence of thrombosis, the alternative reconstruction of the hepatic artery must be considered, and in such sense, the graft from the iliac artery of donor has been used as arterial reconstruction element. The purpose was to review the literature and to describe series where it was used iliac artery arterial grafts for revascularization of the implants in orthotopic liver transplantation in the Liver Transplant Unit at the State University of Campinas from 1998 to 2015. It has been performed 15 transplants needing arterial graft: 8 cases of male, mean age 50 years. Indications to use the graft were: 7 retransplant thrombosis in early hepatic artery (47%), 5 transplantations with hepatic artery already thrombosed in the first implant (35%), 1 retransplantation for late arterial thrombosis (6%), 1 retransplantation due to biliary complications (6%), 1 patient due to post-chemoembolization arterial injury still preoperatively with impossibility of using the celiac trunk (6%). The mean operative time was 420 minutes, mean transfusion of packed red blood cells was 5 units. Post-procedure survival at 6 months was 60% at 1 year and 53%. The literature confirms the good prognosis observed in our cases pointing this maneuver as safe and effective, with some studies supporting it as technique of choice in cases of retransplantation due to hepatic artery thrombosis.