Backtable arterial reconstructions in liver transplant: where are we?

Abstract

Introduction: Liver transplantation is a complex and challenging procedure. Arterial reconstructions on the backtable are essential for proper arterial anastomoses to be provided to the patient. Although the general incidence, is low, TAH is a fact that can lead to several devastating effects, voraciously increasing the mortality of the patient, and due to the frequent anastomoses in the hepatic arterial reconstruction, the risk for this complication has a major increase, bringing the possibility of graft loss. Another set of possible complications to the arterial reconstruction on the backtable in an orthotopic liver transplant are anastomotic biliary complications. Purpose: It aims to review the main complications resulting from arterial reconstruction and their respective causes in liver transplantation, as well as to identify patients exposed to risk factors to develop these contexts. Methods: A literature review of PUBMED was carried out at. The combination of the keywords Liver transplant AND Arterial reconstruction AND complication was used. Results: Vascular complications after liver transplantation significantly increase morbidity, and may contribute, for example, to graft loss and biliary ischemia. The risk factors for the development of TAH are not yet fully understood. It is recommended to use a shorter arterial graft in order to avoid the occurrence of TAH. In addition to the technical aspect being crucial to define the prognosis, other determining factors are described in the literature, such as immunological factors, abnormalities in the coagulation process, smoking, infections and above 60 years old donors.The key to the successful arterial reconstruction is the careful selection and preparation of an appropriate recipient. Conclusion: It is essential that surgeons are able to detect the associated risk factors, clinically recognizing such situations and acting early in order to preserve the patient from graft loss and a likely retransplantation, thus improving the survival and quality of life of those individuals after transplantation.