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Analysis of Risk Factors Affecting the Development of Infection in Artificial Vascular Grafts Used for Reconstruction of Middle Hepatic Vein Tributaries in Living Donor Liver Transplantation

Koc, Cemalettin MD1; Akbulut, Sami MD1; Ozdemir, Fatih MD1; Kose, Adem MD2; Isik, Burak MD1; Yologlu, Saim MD3; Yilmaz, Sezai MD1

doi: 10.1097/TP.0000000000002583
Original Clinical Science—Liver
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Background. To analyze the risk factors affecting the development of infection in artificial vascular grafts (AVGs) used for reconstruction of middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT).

Methods. Between January 2009 and January 2018, 1253 right lobe LDLTs were performed at our Transplant Institute, and MHV tributaries of the 640 right lobe liver grafts were reconstructed with AVG. Reconstructed MHV tributaries were removed due to AVG infection in 25 of these patients (case group; n = 25). To determine risk factors for AVG infection, right lobe LDLT patients without AVG infections were selected as control group (n = 615). Both groups were compared about demographic parameter, transcystic catheter usage, bile leakage, type of biliary anastomosis (duct-to-duct, telescopic duct-to-duct), number of graft biliary duct (=1 versus >1), number of biliary anastomosis (=1 versus >1), AVG thrombosis, AVG types (Dacron versus polytetrafluoroethylene). Univariate analyses were used for comparison of different variables, and variables with P ≤ 0.20 were taken into logistic regression model.

Results. Univariate analysis shows that statistically significant differences were found between groups regarding bile leakage (P < 0.001), graft thrombosis (P = 0.002), transcystic catheter (P = 0.049), and AVG types (P = 0.013). Variables with P ≤ 0.20 were taken into logistic regression model. Multivariate analysis shows that bile leakage (odds ratio, 13.3) and AVG thrombosis (odds ratio, 9.8) were determined as independent and strong risk factors for development of AVG infection.

Conclusions. This study revealed that bile leakage and graft thrombosis are independent and strong risk factors for infections of AVGs used for anterior sector drainage reconstruction.

1 Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

2 Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya, Turkey.

3 Department of Biostatistics, Inonu University Faculty of Medicine, Malatya, Turkey.

Received 19 September 2018. Revision received 10 December 2018.

Accepted 16 December 2018.

The authors declare no funding or conflicts of interest.

This study was presented orally at the International Liver Transplantation Society (ILTS) Annual Congress, May 23-26, 2018, Lisbon, Portugal.

S.A., C.K., A.K., and B.I. have contributed to the study’s concept, design, data collection, data analysis, interpretation, and article writing. S.A., A.K., and S.Y. have contributed to the data collection and approved the article’s final version. S.A. and S.Y. have contributed to the statistical analysis. All authors have approved the article’s final version.

Correspondence: Sami Akbulut, MD, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10 km, Malatya 44280, Turkey. (akbulutsami@gmail.com).

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