dc.contributor.author
Dziodzio, Tomasz
dc.contributor.author
Martin, Friederike
dc.contributor.author
Gül‐Klein, Safak
dc.contributor.author
Globke, Brigitta
dc.contributor.author
Ritschl, Paul Viktor
dc.contributor.author
Jara, Maximilian
dc.contributor.author
Hillebrandt, Karl‐Herbert
dc.contributor.author
Nösser, Maximilian
dc.contributor.author
Koulaxouzidis, Georgios
dc.contributor.author
Fehrenbach, Uli
dc.contributor.author
Gratopp, Alexander
dc.contributor.author
Henning, Stephan
dc.contributor.author
Bufler, Philipp
dc.contributor.author
Schöning, Wenzel
dc.contributor.author
Schmelzle, Moritz
dc.contributor.author
Pratschke, Johann
dc.contributor.author
Witzel, Christian
dc.contributor.author
Öllinger, Robert
dc.date.accessioned
2022-11-30T12:20:01Z
dc.date.available
2022-11-30T12:20:01Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/37106
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-36819
dc.description.abstract
Introduction: In pediatric liver transplantation (pLT), hepatic artery thrombosis (HAT) is associated with inferior transplant outcome. Hepatic artery reconstruction (HAR) using an operating microscope (OM) is considered to reduce the incidence of HAT.
Methods: HAR using an OM was compared to a historic cohort using surgical loupes (SL) in pLT performed between 2009 and 2020. Primary endpoint was the occurrence of HAT. Secondary endpoints were 1-year patient and graft survival determined by Kaplan-Meier analysis and complications. Multivariate analysis was used to identify independent risk factors for HAT and adverse events.
Results: A total of 79 pLTs were performed [30 (38.0%) living donations; 49 (62.0%) postmortem donations] divided into 23 (29.1%) segment 2/3, 32 (40.5%) left lobe, 4 (5.1%) extended right lobe, and 20 (25.3%) full-size grafts. One-year patient and graft survival were both 95.2% in the OM group versus 86.2% and 77.8% in the SL group (p = .276 and p = .077). HAT rate was 0% in the OM group versus 24.1% in the SL group (p = .013). One-year patient and graft survival were 64.3% and 35.7% in patient with HAT, compared to 93.9% and 92.8% in patients with no HAT (both p < .001). Multivariate analysis revealed HAR with SL (p = .022) and deceased donor liver transplantation (DDLT) (p = .014) as independent risk factors for HAT. The occurrence of HAT was independently associated with the need for retransplantation (p < .001) and biliary leakage (p = .045).
Conclusion: In pLT, the use of an OM is significantly associated to reduce HAT rate, biliary complications, and graft loss and outweighs the disadvantages of delayed arterial perfusion and prolonged warm ischemia time (WIT).
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
hepatic artery reconstruction
en
dc.subject
hepatic artery thrombosis
en
dc.subject
operating microscope
en
dc.subject
pediatric liver transplantation
en
dc.subject
surgical loupes
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Hepatic artery reconstruction using an operating microscope in pediatric liver transplantation—Is it worth the effort?
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.articlenumber
e14188
dcterms.bibliographicCitation.doi
10.1111/petr.14188
dcterms.bibliographicCitation.journaltitle
Pediatric Transplantation
dcterms.bibliographicCitation.number
2
dcterms.bibliographicCitation.originalpublishername
Wiley
dcterms.bibliographicCitation.volume
26
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
DEAL Wiley
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
34719848
dcterms.isPartOf.issn
1397-3142
dcterms.isPartOf.eissn
1399-3046