Celiac trunk stenosis by median arcuate ligament in orthotopic liver transplantation: a potential hidden foe to the biliary tree.

Autor:	Lazzarotto-da-Silva G; Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil. Electronic address: gabriel.lazzarotto94@gmail.com., Santos LM; Radiology Unit, Hospital de Clínicas de Porto Alegre, Brazil., Lucena IRS; Radiology Unit, Hospital de Clínicas de Porto Alegre, Brazil., Rabolini BB; Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil., Hallal CP; Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil., Feier FH; Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil., Grezzana-Filho TJM; Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil., Chedid MF; Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil., Leipnitz I; Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil., Chedid AD; Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil., de Araujo A; Gastroenterology and Hepatology Unit, Hospital de Clínicas de Porto Alegre, Brazil., Alvares-da-Silva MR; Gastroenterology and Hepatology Unit, Hospital de Clínicas de Porto Alegre, Brazil., Kruel CRP; Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2024 Jan; Vol. 26 (1), pp. 137-144. Date of Electronic Publication: 2023 Sep 06.
DOI:	10.1016/j.hpb.2023.09.007
Abstrakt:	Background: Celiac trunk compression by the median arcuate ligament (MAL) increases the risk of ischemic complications following gastrointestinal surgical procedures. Previous studies suggest increased risk of hepatic artery thrombosis (HAT) in orthotopic liver transplant (OLT) recipients. The aim of this study is to investigate the impact of untreated MAL compression (MAL-C) on biliary complications in OLT. Methods: Contrast-enhanced imaging was used to classify celiac trunk stenosis by MAL-C. Medical records were reviewed to extract pre-transplant, transplant and post-transplant data. Patients were divided into two groups: no MAL compression (nMAL-C) and MAL-C. The primary endpoint was biliary complications. Secondary endpoints were HAT and graft survival. Results: 305 OLT were performed from 2010 to 2021, of which 219 were included for analysis: 185 (84.5%) patients without and 34 (15.5%) with MAL-C. The incidence of HAT was 5.9% in both groups. Biliary complications were more common in the MAL-C group (35.3% vs. 17.8%, p = 0.035). Graft survival was decreased in patients with MAL-C (p = 0.035). Conclusions: MAL-C of the celiac trunk was associated with increased risk of biliary complications and inferior graft survival in OLT patients. These findings highlight the importance of preoperative screening and treatment of MAL in this population. (Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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