All roads lead to Rome: Aortohepatic conduits as an alternative source of arterial inflow in pediatric liver transplants
Isabel González-Barba Neira1, Jose Andrés Molino 1,2, Jesus Quintero3, Mercedes Pérez4, Concepción Gómez-Gavara2, Cristina Dopazo2, María Marget Mercadal-Hally3, Cristina Padros 3, Mireia Caralt 2, Itxarone Izaskun Bilbao2, Ernest Hidalgo2.
1Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain; 2Department of Hepatobiliary and Pancreatic Surgery and Transplants, Vall d'Hebron University Hospital, Barcelona, Spain; 3Pediatric Hepatology and Liver Transplant Unit, Vall d'Hebron University Hospital, Barcelona, Spain; 4Interventional Radiology Unit, Vall d'Hebron University Hospital, Barcelona, Spain
Introduction: Aortohepatic conduits (AHC) represent an alternative source of inflow when receptor or graft characteristics preclude standard hepatic arterial reconstruction, especially in the pediatric population where donor-recipient size discrepancies are more common.
Methods: A retrospective analysis of pediatric liver transplant (pLT) recipients from 2016-2023 who required an AHC.
Results: Out of 150 pLT, 23 patients (8 female/15 male, with a mean age and weight of 45.3±55.2 months and 13.6±11.7 kg) received 24 AHC (16%): 8 were cadaveric whole-organ grafts (33.3%), 4 reduced cadaveric grafts (16.7%), 9 split grafts (37.5%) and 3 living-donor grafts (12.5%). AHC were employed in 19 first-time graft recipients and in 5 retransplants. Primary pLT indications included: inborn errors of metabolism (IEM) (11), Alagille syndrome (ALG) (4), biliary atresia (4), and others (4).
Indications for AHC included: poor native arterial perfusion (9), size discrepancy (7), complex anatomy of the arterial inflow (4), and technical challenges in surgical exposure (1). Conduit types employed included the iliac artery (22), splenic artery (2) and abdominal aorta (2). In 20 (83%) AHC the infrarenal aorta was the source of arterial inflow. The remaining 4 conduits (17%) were supraceliac.
During a 48.8±28.7 month follow-up, all patients have patent conduits. 4 patients presented arterial complications, 2 required retransplantation and 1 passed away, resulting in a graft and patient survival rate of 91.7% and 95.8%, respectively.
Conclusion: AHCs are a viable alternative for graft arterialization in smaller children, inborn errors of metabolism, Alagille syndrome and retransplants.
[1] Aortohepatic conduits
[2] Alternative hepatic inflow source
[3] Alagille syndrome
[4] Inborn errors of metabolism
[5] Retransplants