DONOR VASCULAR GRAFTS FOR ARTERIAL RECONSTRUCTION IN PEDIATRIC LIVER-TRANSPLANTATION

The authors compared the results of 48 orthotopic liver transplantatio ns (OLT) in which revascularization was achieved with a conduit interp osed between the receptor aorta and the graft (vascular graft [VG] gro up) with those obtained for 56 OLT performed during the same period (1 991 to 1994) in which end-to-end anastomosis (EEA) of the hepatic arte ries or celiac trunk was used (EEA group). In the VG group, the interp osed conduits were the cadaveric iliac artery (37) the living-donor sa phenous vein (3), or nonthrombosed conduits from previous transplants (8) (7 iliac arteries, 1 saphenous vein). There were significant diffe rences between the two groups with respect to recipient age, recipient weight, the retransplant:first transplant ratio, the number of emerge ncy transplantations, the use of reduced-size grafts, and intraoperati ve transfusion requirements. Twenty-nine grafts in the VG group (60.4% ) and 43 in the EEA group (76.7%) currently are functioning. The actua rial 3-year graft survival rates are 60% and 71.5% for the VG and EEA groups (P <.05), respectively. The rate of arterial thrombosis did not differ between the two groups. The authors conclude that, although EE A of the hepatic artery is still the preferred revascularization techn ique for OLT, revascularization of the liver graft by conduit interpos ition is safe when EEA is not possible. Reutilization of the interpose d conduit during retransplantation proved to be safe in the absence of hepatic artery thrombosis. (C) 1996 by W.B. Saunders Company