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Abstract：
BACKGROUND: 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.
OBJECTIVE: To examine the outcomes of patients who required PVA in correlation with their LT procedure.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
OBJECTIVE: To examine the outcomes of patients who required PVA in correlation with their LT procedure.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：门静脉动脉化（PVA）已用于肝移植（LT），以在动脉循环受损时最大化氧气输送，或已用作复杂门静脉血栓形成（PVT）的替代再灌注技术。尚未评估PVA对门静脉灌注和原发性移植物功能障碍（PGD）的影响。
目的：检查需要PVA的患者的结局与LT手术的相关性。
方法：对2011年至2022年在圣达菲波哥大基金会接受PVA和LT的所有患者进行分析。考虑到移植物灌注的时间敏感效应，患者分为两组：再灌注前（pre-PVA），如果在移植物血运重建之前进行了动静脉吻合术，和灌注后（PVA后），如果随后进行PVA。PVA之前的基本原理考虑了门静脉血流动力学不良，严重的血管盗血,或PVT。如果移植物灌注不足变得明显，则考虑PVA后。在PVA之前尝试保守干预。
结果：共25例：移植再灌注前15例，移植后10例。Pre-PVA患者受糖尿病的影响更大，失代偿期肝硬化,门静脉（PV）血流动力学受损，PVT。pre-PVA后PGD较少见(20.0%vs60.0%)(P=0.041)。发生PGD的患者动脉化后PV速度（25.00cm/svs73.42cm/s）（P=0.036）和流量（1.31L/minvs3.34L/min）（P=0.136）的增加较小。9例患者需要PVA闭合（中位时间：62d）。Pre-PVA和非PGD病例的生存率优于其同行（56.09个月比22.77个月和54.15个月比31.91个月，分别)。
结论：这是LT中最大的PVA报告。结果表明，pre-PVA比post-PVA提供更好的移植物灌注。移植物高灌注对PGD有保护作用。
目的：检查需要PVA的患者的结局与LT手术的相关性。
方法：对2011年至2022年在圣达菲波哥大基金会接受PVA和LT的所有患者进行分析。考虑到移植物灌注的时间敏感效应，患者分为两组：再灌注前（pre-PVA），如果在移植物血运重建之前进行了动静脉吻合术，和灌注后（PVA后），如果随后进行PVA。PVA之前的基本原理考虑了门静脉血流动力学不良，严重的血管盗血,或PVT。如果移植物灌注不足变得明显，则考虑PVA后。在PVA之前尝试保守干预。
结果：共25例：移植再灌注前15例，移植后10例。Pre-PVA患者受糖尿病的影响更大，失代偿期肝硬化,门静脉（PV）血流动力学受损，PVT。pre-PVA后PGD较少见(20.0%vs60.0%)(P=0.041)。发生PGD的患者动脉化后PV速度（25.00cm/svs73.42cm/s）（P=0.036）和流量（1.31L/minvs3.34L/min）（P=0.136）的增加较小。9例患者需要PVA闭合（中位时间：62d）。Pre-PVA和非PGD病例的生存率优于其同行（56.09个月比22.77个月和54.15个月比31.91个月，分别)。
结论：这是LT中最大的PVA报告。结果表明，pre-PVA比post-PVA提供更好的移植物灌注。移植物高灌注对PGD有保护作用。
