Use of Aortohepatic Conduit in Liver Transplantation: Experience of Two Decades

Introduction:  Aortohepatic conduits (AHC) are an alternative for graft revascularization when conventional arterial anastomosis is not feasible. They are usually made from the donor iliac artery and anastomosed to the infrarenal or supraceliac aorta. Although essential in some cases, the results in the literature are conflicting.

Objectives:  To analyze the outcomes of the graft and patients undergoing primary liver transplantation (LTx) or retransplantation with aortohepatic conduits over 24 years. Methods: This is a retrospective and observational study analyzing medical records of patients who underwent LTx by a Brazilian team from 2000 to 2024. Patients aged 12 years or older who underwent revascularization using an aortohepatic conduit were included. Data on donors, recipients, surgical techniques, and intra- and postoperative outcomes were collected.

Results:  1.799 LTx procedures were performed during the study period, 43 used arterial conduits, and 41 were included in the final analysis. Most patients were male, with a mean age of 39.24 years. Among the 41 transplants, 17 were primary, and 24 were retransplants. All conduits were made with grafts from donor iliac and/or carotid arteries. The main indications for their use were arterial thrombosis and dissection or friability of the vascular intima. The mean hospital stay was 13 days, and the mean overall survival was 38.51 months. Postoperative complications included arterial thrombosis and biliary complications.

Conclusion:  Aortohepatic conduits in LTx are a life-saving strategy in specific cases despite the increased risk of arterial thrombosis and biliary complications. Endovascular intervention shows promise, but prospective studies are needed to define the ideal anastomosis site, assess its impact on survival, and determine the role of antiplatelet therapy in this context.

Descriptors
Liver Transplantation; Vascular Graft; Vascular Surgical Procedures