Systematic Review
Copyright ©The Author(s) 2018.
World J Hepatol. Oct 27, 2018; 10(10): 752-760
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.752
Table 1 Summary of findings of the nine included studies
ReferenceCountryPopulation (n)Study designMethod used for diagnosis and follow-up durationInterventionOutcomeMain results
Sabra et al[37]Japan113 pediatric LDLTRetrospectiveDoppler US twice daily till 1st week. If any PV complications were found, specific tests such as angiography were performed 1 yr of follow-upPV reconstruction with VG (31 pts) PV reconstruction with EEA (82 pts)Preoperative recipient factors PVT incidence Pt survival Graft survivalGlobal incidence PVT (2.6%) in the first 3 mo after OLT 1 PVT in 31 VGs vs 2 PVT in 82 without VGs No significant difference for PVT, Pt survival, Graft survival In the two groups
Julka et al[38]Taiwan87 pediatric LDLTRetrospectiveRoutine doppler US post LT; CT angiography for HAT confirmation 5 yr of follow-upHA reconstruction with two arterial stumps. 2 HA stumps with 2 HA reconstruction = 20 pts 2 HA stumps with 1 HA reconstruction = 22 pts 1 HA stump with 1 HA reconstruction = 45 ptsHAT incidence BC incidenceOverall HAT incidence 6.9% The incidence of HA thrombosis and biliary complications was similar in the three groups
Saad et al[39]Japan110 LDLT in pediatric ptsRetrospective LDLTDoppler US, performed routinely before, during and after surgery Follow-up not definedDifferent types of portal vein reconstructions Type 1: End- to- end anastomosis = 36 pts Type 2: Branch patch anastomosis = 27 pts Type 3: Anastomosis to the confluence (superior mesenteric vein-splenic vein) = 16 pts Type 4: Vein graft = 32 pts Chosen according to the surgical evaluationC TC SC Survival rateType 1: 1 SC / 36 pts Type 2: 2 TC / 27 pts Type 3: 0 / 16 pts Type 4: 1 TC / 32 pts Overall survival rate 86%
Shackleton et al[31]California194 pediatric OLT for biliary atresia (mixed LDLT and DDLT)RetrospectiveClinical suspect confirmed by angiography and/or surgical exploration. 3 yr of follow-upGr 1: Conventional artery reconstruction (n = 166) Gr 2: MHR (n = 28)Risk factors for HAT Impact of MHR on incidence of HAT, need of re-OLT, patient and graft survivalImpact of MHR HAT incidence: Gr 1 32/166 (19%) vs Gr 2 0/28 (0%), P = 0.006 Re-OLT: Gr 1 31/166 (19%) vs Gr 2 1/28 (4%), P = 0.05 1 yr actuarial survival: Gr 1 81% vs Gr 2 100%, P = 0.02 (univariate analysis) BUT P = 0.076 in step wise Cox regression for patient survival
López et al[32]Spain104 OLT in 82 pediatric pts (mixed LDLT and DDLT)RetrospectiveDoppler US routinely and selective arteriography for confirmation. 3 yr of follow-upArterial revascularization technique: Gr 1 (n = 48) AhG Gr 2 (n = 56) EEA Chosen according to the surgical evaluationHAT incidence Survival rateHAT incidence Gr 1. (AhG): 6.25% Gr 2. (EEA): 8.92% (P not significant) Graft Survival rate (1 yr) 61.5% (AhG) vs 60% (EEA) (P < 0.05) Graft survival rate (5 yr): 77.5% (AhG) vs 75.1% (EEA) (P < 0.05)
Millis et al[33]Illinois66 pediatric LDLT and 48 pediatric cadaveric RLTRetrospectiveDoppler US every day for the first 3 d and at 1, 3, 6, 12, 18, and 24 mo after transplantation + angiography for confirmation 5 yr of follow-upPortal anastomosis with venous graft conduit in LDLT Gr 1 (n = 18): Native reconstructed vein Gr 2 (n = 37): Cryopreserved iliac vein; Gr 3 (n = 11): Cryopreserved femoral veinIncidence of PVC Graft survival Patient survivalIncidence PVC LDLT 33/66 (50%) vs RLT 4/48 (8%) P < 0.0001 Early PVT LDLT Gr 1: 6 (33%)a LDLT Gr 2: 3 (8%) LDLT Gr 3: 1 (9%) RLT: 2 (4%) aP < 0.005 vs RLT Late PVC LDLT Gr 1: 3 (16%) LDLT Gr 2: 19 (51%)a LDLT Gr 3: 1 (9%) RLT: 2 (4%) aP < 0.005 vs RLT; P < 0.02 vs Gr 1 and Gr 3 Graft survival PVC: 61% No PVC: 67%, P = NS Patient survival: PVC: 67% No PVC: 71%, P = NS
Jurim et al[34]California35 pediatric OLT Emergency transplants only (type of donor not specified)RetrospectiveNot reported. Follow-up not definedGr 1: RLT = 7 pts Gr 2: Whole graft = 18 ptsHAT incidence Incidence of other complications: Biliary; bleeding; chronic rejectionHAT: Gr 1:0 (0%)/Gr 2:5 (29%) (P < 0.05) The incidence of biliary complications, bleeding (requiring surgical exploration) and chronic rejection were similar between the groups
Yandza et al[35]France143 DDLT in 122 pediatric ptsRetrospectiveDoppler US daily the first 15 d, twice/wk until discharge Follow-up not definedGr 1 (n = 41 pts, n = 50 grafts) children < 10 kg Gr 2 (n = 81 pts, n = 93 grafts) children > 10 kg Surgical technique: EEA vs AhGEffect of the site of liver graft arterial inflow on HAT incidence according to the recipient weightOverall HAT incidence: 14/143 (10%) HAT incidence between the 2 groups: Gr 1: 6/50 (12%) vs Gr 2: 8/93 (9%), P not significant; Gr 1 EEA 5/31 (16%) vs Gr 1 AhG 1/19 (5%); P not significant Gr 2 EEA 4/60 (6%) vs Gr 2 AhG 4/32 (12%) P not significant
Stevens et al[36]Chicago134 OLT in 100 pediatric pts < 2 yr : mixed LDLT and DDLTRetrospectiveDoppler US, frequency not defined Follow-up60 standard whole liver vs 74 RLT (13 LDLT) Surgical technique: Arterial inflow with 83 hepatic artery vs 32 celiac artery vs 5 supraceliac aorta vs 27 infrarenal aorta vs 7 unusual reconstructionEffect of the graft type and site of arterial inflow on the Incidence of HATHAT incidence in 25% whole liver transplant vs 23% in LDLT vs 15% RLT (P = 0.06) Aortic anastomosis (supraceliac and infrarenal) reduces incidence of HAT (6% vs 24%, P = 0.02)