Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.92528
Revised: February 19, 2024
Accepted: April 28, 2024
Published online: June 18, 2024
Processing time: 137 Days and 9.9 Hours
Portal vein arterialization (PVA) has been used in liver transplantation (LT) to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis (PVT). The effect of PVA on portal perfusion and primary graft dysfunction (PGD) has not been assessed.
To examine the outcomes of patients who required PVA in correlation with their LT procedure.
All patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were analyzed. To account for the time-sensitive effects of graft perfusion, patients were classified into two groups: prereperfusion (pre-PVA), if the arterioportal anastomosis was performed before graft revascularization, and postreperfusion (post-PVA), if PVA was performed afterward. The pre-PVA rationale contemplated poor portal hemodynamics, severe vascular steal, or PVT. Post-PVA was considered if graft hypoperfusion became evident. Conservative interventions were attempted before PVA.
A total of 25 cases were identified: 15 before and 10 after graft reperfusion. Pre-PVA patients were more affected by diabetes, decompensated cirrhosis, impaired portal vein (PV) hemodynamics, and PVT. PGD was less common after pre-PVA (20.0% vs 60.0%) (P = 0.041). Those who developed PGD had a smaller increase in PV velocity (25.00 cm/s vs 73.42 cm/s) (P = 0.036) and flow (1.31 L/min vs 3.34 L/min) (P = 0.136) after arterialization. Nine patients required PVA closure (median time: 62 d). Pre-PVA and non-PGD cases had better survival rates than their counterparts (56.09 months vs 22.77 months and 54.15 months vs 31.91 months, respectively).
This is the largest report presenting PVA in LT. Results suggest that pre-PVA provides better graft perfusion than post-PVA. Graft hyperperfusion could play a protective role against PGD.
Core Tip: Guaranteeing adequate graft perfusion is essential to obtain optimal outcomes after liver transplantation (LT). This retrospective single-center study analyzed 25 cases of portal vein arterialization (PVA) for portal flow optimization in LT. To account for the time-sensitive effect, cases were classified into two groups: prereperfusion (pre-PVA) if the arterioportal anastomosis was performed before graft revascularization and postreperfusion (post-PVA) if PVA was performed afterward. We found that pre-PVA yields better results than post-PVA and that hyperperfusion could play a protective role against graft dysfunction. Currently, this is the largest case series studying PVA during LT.