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Ischemic Arterial Complications After Liver Transplantation in the Adult
Multivariate Analysis of Risk Factors
Marco Vivarelli, MD;
Alessandro Cucchetti, MD;
Giuliano La Barba, MD;
Roberto Bellusci, MD;
Antonio De Vivo, MD;
Bruno Nardo, MD;
Antonino Cavallari, MD;
Antonio D. Pinna, MD
Arch Surg. 2004;139:1069-1074.
Hypothesis To minimize the incidence of ischemic arterial complications, risk factors should be clearly identified. Knowledge of the predisposing factors for such complications would make possible the institution of strict surveillance protocols that could ensure early detection of complications and so prevent the progression of ischemic damage to graft failure.
Design Retrospective univariate and multivariate analysis.
Setting University hospital.
Patients Six hundred fifty-three adults who underwent 747 orthotopic liver transplantations.
Main Outcome Measures We used univariate and multivariate analyses to retrospectively assess the role of possible risk factors for early and late HA thrombosis (HAT) and stenosis (HAS), including etiology of liver disease, donor and recipient sex and age (aged  60 vs >60 years), cause of donor death, preservation solution, cold ischemic time, previous orthotopic liver transplantation, HA back-table reconstruction, direct arterial anastomosis vs interpositional conduit, experience of the surgeon, intraoperative transfusion requirements, acute rejection, and cytomegalovirus infection.
Results We observed 58 ischemic complications, including 26 early HAT, 13 late HAT, and 19 HAS. Independent predictors of early HAT were donor age greater than 60 years and bench reconstruction of anatomical variants of the HA; of late HAT, arterial anastomosis fashioned using an interpositional graft of donor iliac artery (iliac conduit) and donors who died of cerebrovascular accident; and of HAS, previous orthotopic liver transplantation and cytomegalovirus infection.
Conclusions Predisposing factors for HAT mostly stem from donor and graft features. Use of iliac conduits should be limited, particularly when using old donors. Frequent screening of the arterial flow to the graft with Doppler ultrasonography is advisable in patients at risk.
From the Department of Surgery and Transplantation (Drs Vivarelli, Cucchetti, La Barba, Bellusci, Nardo, Cavallari, and Pinna) and the Institute of Haematology and Clinical Oncology L.&A. Seragnoli (Dr De Vivo), University of Bologna, S. Orsola Hospital, Bologna, Italy.
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