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Master Thesis

Complications vasculaires après transplantation hépatique : prise en charge et résultats

Abstract : Background: Intraoperative vascular-related difficulties and postoperative vascular complications are the Achilles’ heel of liver transplantation (LT). The aim of the study was to describe the intraoperative management of vascular difficulties and of postoperative vascular complications, and their impact on patient outcomes. Methods: All consecutive 201 patients (159 men, median age 59 years) who underwent LT at our center between January 2015 and December 2019 were included. Gordon reconstruction of variant right hepatic artery was performed in 13 (6%) patients and median arcuate ligaments were dissected free during LT in 13 (6.5%). Prior to LT, 75 (37%) patients had received a median of 2 [2,4] chemoembolization procedures. Portal vein (PV) thrombosis was present in 24 (12%) recipients of whom, 7 (3%) required extra-anatomic PV. Results: Operative complications occurred in 194 (96.5%) patients and 18 (9%) patients died within 90 days of LT. Severe complications (Clavien-Dindo > Grade III) were recorded in 137 (68.2%) patients, and 70 (34.8%) patients required reoperation. Primary graft non function (PNF) occurred in 8 (4%) patients, and 16 (8%) patients underwent retransplantation. Arterial complications occurred in 111 (55%) patients including thrombosis (n=22), stenosis, (n=86), bleeding (n=13; 6%) and pseudoaneurysm formation of (n=22). PV-related complications occurred in 55(27%) patients including stenosis (n=46) and thrombosis (n=15). PNF (p<0.0001), hepatic artery rupture (p=0.0003) and extra-anatomic PV reconstruction (p<0.0001) were independent predictors of operative mortality. Overall survival at 1, 3 and 5 years was 86%, 82% and 75%, respectively. Arterial thrombosis (p=0.03), extra-anatomic PV reconstruction (p=0.01) and re-transplantation (p=0.007) were negative predictors of overall survival. Conclusion: Vascular complications occur frequently after LT and have strong influence on postoperative and long term mortality.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03443220
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Tuesday, November 23, 2021 - 2:17:52 PM
Last modification on : Thursday, November 25, 2021 - 3:28:54 AM

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Oyekashopefoluwa Alao. Complications vasculaires après transplantation hépatique : prise en charge et résultats. Médecine humaine et pathologie. 2021. ⟨dumas-03443220⟩

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