Arterial vascular conduits in adult orthotopic liver transplant recipients

BACKGROUND: Vascular conduits may be required to gain arterial inflow to the donor hepatic artery in orthotopic liver transplantation. METHODS: From January 1986 to December 2003, arterial conduits were required in 31/582 (5.3%) adult liver transplant procedures. RESULTS: Indications for the conduit included recipient hepatic artery problems (20); hepatic artery thrombosis previous allograft (7) and other (4). The conduits used in 28/31 cases (90%) were deceased donor iliac arteries and the remainder prosthetic grafts. Patients requiring conduits were more likely to be already hospitalized (P = 0.038) or undergoing a retransplant procedure (P = 0.001) than patients not requiring conduits. Both sepsis and haemorrhage caused death in 8/31 (26%) patients requiring conduits versus 42/551 (7.6%) patients not requiring conduits. Death from thrombosis of the iliac artery conduit occurred in two cases and from bacterial infection of a prosthetic conduit in one case. For retransplant procedures, allograft loss was seen in 11/13 (84%) conduit cases versus 11/28 (39%) non-conduit cases (P = 0.016). Overall allograft survival was significantly lower in the conduit cases than in the non-conduit cases (P = 0.0001), with 12/31 (39%) allografts being lost within the first 3 months post-transplantation for the conduit cases. CONCLUSION: Arterial vascular conduits are more commonly required in adult liver transplant recipients who are hospitalized or undergoing retransplant procedures. Allograft survival is poorer in the conduit cases and is associated with complications, particularly sepsis and haemorrhage, following retransplantation procedures.