USE OF VASCULAR CONDUITS IN PAEDIATRIC LIVER TRANSPLANTATION

1
USE OF VASCULAR CONDUITS IN PAEDIATRIC LIVER
TRANSPLANTATION

• H Tanaka1, D Verran1, P Dilworth1, M Stormon2,
• A Shun2
• Australian National Liver Transplant Unit,
• Royal Prince Alfred Hospital1, The Children's
  Hospital Westmead2, Sydney, Australia

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Background

• Revascularization of the liver allograft in paed
  OLTx may be technically difficult
• Use of either the portal vein and or the hepatic
  artery may not be practical
• This may require the use of vascular conduits

3
AIM

• Analyze the results of paed OLTx performed at our
  center comparing OLTX procedures performed with
• vascular conduits versus OLTx without vascular
  conduits

4
Methods

• Retrospective analysis of all paed OLTx from
  1/1986 to 12/2003 with a minimum of 1 year follow
  up
• Paediatric-defined as lt 15 yrs
• Review of database and records from Australian
  National Liver Transplant Unit
• Data analysis by SPSS/SISA

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Results-Demographics
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Results Underlying Liver Disease
P 0.004 for Retx procedures
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Type of Allograft
P 0.45
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Indications for conduits
Portocaval hemitransposition-retx procedure
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Type of conduit
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Configuration Arterial Conduits
Donor vessel 1 Recipient vessel 2
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Configuration Venous Conduits

• 1 donor iliac vein to confluence of recipient
  SMV/splenic veins
• 1 donor iliac vein to recipient splenic vein
• 2 donor iliac vein to recipient SMV
• 1 donor iliac vein to recipient suprarenal
  IVC(portocaval hemitransposition)

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Allograft outcome

• Graft loss
• 37/121 (30.5) in Non-Conduit Group vs. 8/20
  (40) in Conduit Group (p0.7)
• Graft loss for re-transplant procedures
• 5/9 (55) in Non-Conduit Group
• vs. 4/8 (50) in Conduit Group (p0.8)

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Incidence Allograft Loss versus Total Number
OLTx- 86-94 vs 95-03
P 0.002 allograft loss
86-94 vs 95-03
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Allograft Outcome-Arterial Conduits

• 16 procedures in 13 recipients( 1 combined
  arterial venous conduits)
• 3/13 recipients allograft loss from patient
  death(1 cerebral damage 1 gastric perforation
  sepsis post retx 1 sepsis)
• 4 allografts lost from vascular comps- 3 HAT
• -gt biliary comps 1 portal vein IVC
  strictures. All managed by retx
• 1 allograft lost from non-thrombotic infarction
• -gtretransplant

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Allograft Outcome-Venous Conduits

• 5 conduit procedures in 5 patients
• All 5 cases a w
  
  
  
  
  
  
  
  
  
  
  
  

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Underlying Cause of Allograft Loss
Non-Conduit Cases(n37)
Conduit Cases (n8)
P0.66
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Conclusions

• Vascular conduits predominantly with deceased
  donor vessels are required for allograft inflow
  in 14 of paed OLTx
• more common in the retransplant setting
• The most common indication is an inadequate
  recipient hepatic artery, followed by HAT for
  arterial conduits
• Allograft loss from vascular complications is
  more common in the OLTx with conduits