Portal vein arterialization in 25 liver transplant recipients: A Latin American single-center experience

Table 1 Recipient characteristics according to the timing of portal vein arterialization

Basic characteristics	Pre-reperfusion PVA	%	Post-reperfusion PVA	%	Overall	%	P value
n	15	60.0	10	40.0	25	100.0
Sex (male)	8	53.3	5	50.0	13	52.0	0.870
Age (yr)	54.06 [27.0-71.0; 12.1]1		53.20 [10.0-78.0; 20.3]1		53.72 [10.0-78.0; 15.5]1		0.895
Body composition							0.708
Underweight	1	6.7	1	10.0	2	8.0
Normal	6	40.0	6	60.0	12	48.0
Overweight	6	40.0	2	20.0	8	32.0
Obesity	2	13.3	1	10.0	3	12.0
Liver disease
Etiology							0.459
Congenital biliary atresia	0	0.0	1	10.0	1	4.0
Non-alcoholic steatohepatitis	3	20.0	2	20.0	5	20.0
Alcoholic	3	20.0	2	20.0	5	20.0
Autoimmunity2	4	26.7	3	30.0	7	28.0
Hepatitis C	2	13.3	0	0.0	2	8.0
Hepatocellular carcinoma	0	0.0	1	10.0	1	4.0
Hemochromatosis	1	6.7	1	10.0	2	8.0
Cryptogenic	1	6.7	0	0.0	1	4.0
Secondary biliary cirrhosis	1	6.7	0	0.0	1	4.0
Prior primary non-functioning	3	20.0	0	0.0	3	12.0	0.132
CHILD Pugh Score B/C	15	100.0	7	70.0	22	88.0	0.024
MELD Score ≥ 20 points	4	26.7	5	50.0	9	36.0	0.234
Primary hepatic neoplasia	1	6.7	5	50.0	6	24.0	0.013
Hepatic encephalopathy	7	46.7	6	60.0	13	52.0	0.513
Ascites	13	86.7	6	60.0	19	76.0	0.126
Hypertensive gastropathy	7	46.7	6	60.0	13	52.0	0.513
Upper gastrointestinal bleeding	8	53.3	2	20.0	10	40.0	0.096
Hepatorenal syndrome	2	13.3	1	10.0	3	12.0	0.802
Comorbidities
Type 2 diabetes mellitus	7	46.67	0	0.0	7	28.0	0.011
Hyperlipidemia	1	6.7	3	30.0	4	16.0	0.119
Arterial hypertension	4	26.7	2	20.0	6	24.0	0.702
Cardiac failure	1	6.7	1	10.0	2	8.0	0.840
Hemodynamic support	2	13.3	1	10.0	3	12.0	0.840
Chronic renal insufficiency	1	6.7	0	0.0	1	4.0	0.535
Acute kidney injury	3	20.0	1	10.0	4	16.0	0.535
Malnourishment	3	20.0	5	50.0	8	32.0	0.124
Decreased bone mineral density	7	46.7	5	50.0	12	48.0	0.427
Pulmonary disease/impairment	9	60.0	0	0.0	9	36.0	0.095
Hypothyroidism	4	26.7	1	10.0	5	20.0	0.381

¹Continuous variable with normal distribution [mean (min-max; SD)]. It was compared using Student’s T test.

²Autoimmune causes of liver disease include primary biliary cirrhosis, autoimmune hepatitis and overlap syndrome. PVA: Portal vein arterialization; MELD: Model for end-stage liver disease.

Table 2 Preoperative portosystemic circulation and portal doppler ultrasound parameters according to timing of portal vein arterialization

	Pre-reperfusion PVA	%	Post-reperfusion PVA	%	Overall	%	P value
n	15	60.0	10	40.0	25	100.0
Collateral portal circulation	13	87.0	7	70.0	20	80.0	0.358
Splenomegaly	12	80.0	6	60.0	18	72.0	0.378
Perigastric/periesophagic varices	7	47.0	5	50.0	12	48.0	1.000
Umbilical vein recanalization	6	40.0	2	20.0	8	32.0	0.402
Paracaval portosystemic shunt	1	7.0	0	0.0	1	4.0	1.000
Epiploic shunts	2	13.0	1	10.0	3	12.0	1.000
Mesenteric varices	3	20.0	0	0.0	3	12.0	0.250
Splenorenal shunts	3	20.0	3	30.0	6	24.0	0.653
Portal vein thrombosis2	13	86.6	3	30.0	16	64.0	0.009
Grade I	3	20.0	0	0.0	3	12.0
Grade II	5	33.3	3	30.0	8	32.0
Grade III	4	26.7	0	0.0	4	15.0
Grade IV	1	7.7	0	0.0	1	4.0
Preoperative doppler ultrasound
Portal vein velocity (cm/s)1	11.60 [8.30-18.86; 10.8]		16.00 [13.10-23.20; 7.6]		14.00 [11.7-19.0; 10.5]		0.048
Portal vein flow (L/min)1	0.59 [0.40-0.70; 0.23]		0.68 [0.40-0.94; 0.80]		0.59 [0.47-0.73; 0.56]		0.367

¹These variables do not have normal distribution [median (p5-95; IQR)]. They were compared using Mann-Whitney’s U test.

²Portal vein thrombosis was classified according to Yerdel’s classification. PVA: Portal vein arterialization.

Table 3 Surgical variables according to the timing of portal vein arterialization

Intraoperative events	Pre-reperfusion PVA	%	Post-reperfusion PVA	%	Overall	%	P value
n	15	60.0	10	40.0	25	100.0
Surgical time (h)	8.60 [7.7-10.90; 3.9]2		5.6 [4.2-8.82; 2.8]2		7.2 [6.8-9.5; 4.30]2		0.004
Arterialization technique							0.130
Supraceliac graft	7	47.0	1	10.0	8	32.0
Infrarenal graft	5	33.0	7	70.0	12	48.0
ARHA	1	7.0	1	10.0	2	8.0
Splenic artery	0	0.0	1	10.0	1	4.0
AMA	2	13.0	0	0.0	2	8.0
Thrombectomy3	6	40.0	3	30.0	9	36.0	0.691
CIT (h)	9.87 [4.0-13.8; 2.4]2		8.81 [4.9-13.7; 2.7]2		9.4 [4.0-13.8; 1.5]2		0.322
CIT > 10 h	6	40.0	3	30.0	9	36.0	0.691
WIT (min)	43.33 [22.0-8.0; 13.8]2		40.50 [24.0-65.0; 12.6]2		42.2 [22.0-78.0; 12.8]2		0.6
WIT > 45 (min)	5		3	30.0	8	32.0	1
PRBCs (Units)	12.00 [6.7-18.0; 13.0]1		4.50 [1.8-12.8; 1]1		10.0 [6.4-14.2; 12.0]1		0.160
Plasma (Units)	18.00 [12.2-3.1;15.0]1		12.00 [8.9-16.5; 8.3]1		12.0 [12.2-22.1; 13.0]1		0.414
Cryoprecipitates (Units)	22.00 [14.0-3.6;1]1		20.00 [7.0-21.4; 20.3]1		20.0 [13.5-3.0; 17.5]1		0.103
Platelets (Units)	12.00 [4.6-4.1; 24.0]1		9.0 [0.0-30.7; 17.0]1		12.0 [7.6-3.1; 27.0]1		0.311
PVA after LT	0	0.0	4	40.0	4	16.0	0.170

¹Continuous variables without normal distribution [median (p5-95; IQR)]. They were compared using Mann-Whitney’s U test.

²Continuous variables with normal distribution [mean (min-max; SD)], they were compared using Student’s T test.

³Whether mechanical thrombectomy or thromboendovenectomy. ARHA: Accessory right hepatic artery; AMA: Accessory mesenteric artery; CIT: Cold ischemia time; WIT: Warm ischemia time; PVA: Portal vein arterialization; LT: Liver transplant; PRBC: Packed red blood cells.

Table 4 30-d Postoperative outcomes according portal vein arterialization timing

Postoperative events	Pre-reperfusion PVA	%	Post-reperfusion PVA	%	Overall	%	P value
n	15	60.0	10	40.0	25	100.0
ICU LOS (d)1	3.00 [0.0-15.1; 4.0]		3.50 [1.6-4.7; 4.2]		3.00 [1.0-10.6; 4.0]		0.935
LOS (d)1	10.00 [0.0-48.0; 17.0]		10.50 [5.5-17.8; 11.7]		10.00 [3.8-33.0; 13.5]		0.849
Hemoperitoneum	1	6.7	1	10.0	2	8.0	1.000
Bowel resection	3	20.0	0	0.0	3	12.0	0.250
Upper gastrointestinal bleeding	3	20.0	3	30.0	6	24.0	0.653
Infection	7	46.7	7	70.0	14	56.0	0.414
Ascites	3	20.0	3	30.0	6	24.0	0.653
Pleural effusion	3	20.0	2	20.0	5	20.0	1.000
Pulmonary complications	6	40.0	2	20.0	8	32.0	0.402
Encephalopathy	4	26.7	6	60.0	10	40.0	0.122
Postoperative atrial fibrillation	1	6.7	1	10.0	2	8.0	1.000
Congestive cardiac failure	1	6.7	1	10.0	2	8.0	1.000
Acute kidney injury	7	46.7	6	60.0	13	52.0	0.688
Hemodialysis requirement	3	20.0	3	30.0	6	24.0	0.653
Reintervention	4	26.7	3	30.0	7	28.0	1.000
Postoperative PVA closure	6	40.0	3	30.0	9	36.0	0.691
PGD	3	20.0	6	60.0	9	36.0	0.041
PNF	1	6.7	4	40.0	5	20.0	0.121
Retransplantation	1	6.7	2	20.0	3	12.0	0.543
30-d mortality	4	26.7	5	50.0	9	36.0	0.397

¹Continuous variables without normal distribution (median [p5-95; IQR]); they were compared using Mann-Whitney’s U test. ICU: Intensive care unit; PVA: Portal vein arterialization, LOS: length of stay, PGD: Primary graft dysfunction; PNF: Primary non-functioning.

Table 5 Comparison of preoperative and postoperative doppler portal ultrasound according to portal vein thrombosis, ligation of spontaneous portosystemic shunts and primary graft dysfunction

Doppler ultrasound parameter	Variable	Preoperative	Postoperative	Delta (post-preoperative)
Portal vein velocity (cm/s)	Overall	14.00 [11.7-19.0; 10.45]	71.00 [58.4-102.8; 68]	52.70 [41.24-89.23; 73.50]
	No PVT	17.00 [13.25-25.98; 12.5]	88.00 [60.68-116.50; 45]	36.80 [13.89-80.699; 79.10]
	PVT	11.80 [8.58-17.50; 8.48]	48.00 [43.09-109.25; 55.91]	60.35 [41.21-109.44; 81.40]
	P value1	0.037	0.169	0.276
	No SPSS	14.00 [7.31-23.40; 12.8]	84.50 [61.62-121.41; 78.4]	75.20 [46.13-109.15; 77.00]
	SPSS	13.50 [11.02-19.82; 9.95]	67.00 [37.51-106.15; 19.16]	25.50 [5.32-87.93; 64.60]
	P value1	0.338	0.115	0.080
	No PGD	11.80 [8.52-18.63; 8.98]	85.82 [64.73-127.48; 80.55]	73.42 [48.78-115.95; 86.00]
	PGD	15.00 [12.53-24.20; 8.6]	46.00 [31.05-75.25; 49.25]	25.00 [9.78-59.78; 65.50]
	P value1	0.890	0.570	0.037
Portal vein flow (L/min)	Overall	0.59 [0.47-0.73; 0.56]	3.6 [2.69-4.99; 4.55]	3.21 [2.09-4.40; 4.24]
	No PVT	0.87 [0.41-1.02; 0.82]	2.68 [3.29-6.04; 3.05]	1.52 [0.65-4.17; 3.22]
	PVT	0.55 [0.40-0.67; 0.47]	2.05 [1.68-5.07; 4.4]	3.35 [2.10-5.31; 4.76]
	P value1	0.187	0.065	0.419
	No SPSS	0.9 [0.73-1.34; 0.32]	2.68 [2.41-5.40; 4.17]	1.77 [1.64-4.63; 3.88]
	SPSS	0.51 [0.38-0.66; 0.5]	3.97 [1.58-5.30; 8.65]	3.26 [1.19-5.59; 5.50]
	P value1	0.002	0.723	0.849
	No PGD	0.75 [0.50-0.82; 0.36]	3.95 [2.96-6.07; 4.73]	3.34 [2.29-5.42; 4.54]
	PGD	0.30 [0.24-0.74; 0.51]	2.20 [0.93-4.33; 3.1]	1.31 [0.41-3.88; 3.09]
	P value1	0.677	0.169	0.136

¹P value corresponds to the significance level of the comparison of either subgroups whether preoperatively, postoperatively or their difference. These variables do not have a normal distribution [median (p5-95; IQR)]. They were compared using Mann-Whitney’s U test. PVT: Portal vein thrombosis; SPSS: Spontaneous portosystemic shunt; PGD: Primary graft dysfunction.