INFLUENCE OF THE ANASTOMOTIC RECONSTRUCTI ON ON VASCULAR COMPLICATIONS FOLLOWING LIVER-TRANSPLANTATION

Aim: Besides primary non function (PNF), vascular complictations are r esponsible for the majority of early surgical and interventional thera py following liver transplantation. The purpose of this study was to e valuate the influence of the variety of arterial anastomosis on postop erative morbidity and mortality.Method used: In 179 liver transplantat ions, vascular (arterial and portal) complications within the first 3 months were analyzed with respect to the type of reconstruction. The a rterial anastomoses were divided into 3 groups according to the recipi ent artery used [Group (I): common hepatic artery (CHA), (II): hepatic artery (HA), (III): aorta]. For statistical analysis comparison of tw o proportions and the logrank test were used. Results: The reconstruct ion was done primarily to the recipient CHA (69%, n=124), less often t o the HA (15%, n=26) or directly to the aorta (16%, n=29). The portal anastomosis - with the exception of two cases (dacron graft and intern al iliac vein interposition)- was always end to end and resulted in fo ur reinterventions (2.2 %, kinking: n=1, thrombosis: n=3). Arterial co mplications (11.7%) like thrombosis, stenosis and dissection (n=17), b leeding (n=2) and steal phenomenon (n=2) occurred more frequently. The difference in one year survival between patients with (n=12/25, 47%) and without (n=42/53, 79%) vascular complications was significant (X(2 )=4.72, FG 1, lo-grank test p<0.05). Conclusion: The rate of complicat ions causing surgical or interventional therapy is independent of the choice of arterial reconstruction. The one year survival rate in patie nts with vascular complications is significantly decreased.