Systematic review and meta-analysis of the role of aorto-hepatic conduits in liver transplant: Known knowns and known unknowns.

Abstract

<h4>Background</h4>Aorto-hepatic conduits (AHCs) are an effective revascularization method for liver allografts when the native hepatic artery is unusable. Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.<h4>Aim</h4>To investigate the published evidence on the outcomes according to different inflow site for AHCs.<h4>Methods</h4>A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years (January 2014 onwards). Two independent reviewers selected articles, assessed quality, and evaluated bias in the included systematic reviews. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. The protocol was registered with PROSPERO (CRD42024545810). Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.<h4>Results</h4>Fourteen studies identified a total of 32486 deceased donor liver transplants, of which 1136 (3.5%) required AHCs. The most frequent indications for AHC use included poor arterial flow, intimal dissections, and hepatic artery thrombosis. Among all AHCs, 207 (18.2%) were supra-coeliac (SC) AHCs, 738 (65.0%) infra-renal (IR) AHCs, 25 (2.2%) iliac artery conduits, and 166 (14.6%) had unspecified origins. Pooled analysis revealed comparable demographic characteristics. The median follow-up duration ranged from 18 to 52 months. There were no significant differences in early occlusions of AHCs [odds ratio (OR) = 0.94 (0.48, 1.84); <i>P</i> = 0.86], late occlusions of AHCs [OR = 0.46 (0.16, 1.32); <i>P</i> = 0.15], early allograft dysfunction [OR = 0.82 (0.46, 1.47); <i>P</i> = 0.51], biliary complications [OR = 1.10 (0.69, 1.76); <i>P</i> = 0.68], post-transplant renal replacement therapy (RRT) requirement [OR = 1.12 (0.72, 1.72); <i>P</i> = 0.62], and major surgical complications (Clavien-Dindo > 3b) [OR = 1.06 (0.70, 1.61); <i>P</i> = 0.79]. The median duration for graft occlusion was approximately 142 days, ranging from 13 to 3313 days. One-year graft and patient survival rates for SC conduits were 77% to 81.1% and 80% to 85.1%, respectively. For IR conduits, one-year graft and patient survival rates were 66% to 79.1% and 73% to 88.3%, respectively. Five-year graft and patient survival rates for SC conduits were 53.9% to 67% and 67.8% to 74%, respectively. For IR conduits, five-year graft and patient survival rates were 50% to 56% and 56% to 64.9%, respectively.<h4>Conclusion</h4>Considering these findings, there is no significant difference in early and late outcomes between SC and IR AHCs, although there is a discernible tendency towards higher late occlusion rates in the IR group.