The Role of Cavoportal and Renoportal Hemitransposition in Liver Transplantation

BACKGROUND: Few series of cavoportal (CPA) or renoportal (RPA) anastomosis have been published and their survival rates have never been compared. The objective of this study was to evaluate perioperative and long-term outcomes of CPA and RPA in a nationwide multicentric series and to compare hemitranspositions (HT) to paired orthotopic liver transplantations (OLT). MATERIAL/METHODS: HT performed in France up to April 2019 were analyzed. Endpoints were the incidence of severe (Clavien-Dindo>IIIa) 90-day perioperative complications and long-term patient and graft survival. RESULTS: Sixty-four HT (13 CPA, 51 RPA) were performed in 59 patients. The rates of perioperative CD>IIIa complications were 64% and 49% in patients with CPA and RPA, respectively (P=0.59), and the rates of portal thrombosis and ascites were 38.5% and 9.8% (p=0.023) and 53.8% and 21.6% (p=0.049) in patients with CPA and RPA, respectively. The patient and graft perioperative survival rates were 54.4% and 83.3% (HR=3.2; CI 95 [1.1–9.9]; p=0.039) and 54.4% and 77.1% (HR=2.2; CI 95 [0.77–6.4]; P=0.14) in the CPA and RPA groups, respectively. Five-year patient survival was 36.4% and 61.8% in the CPA and RPA groups, respectively (HR=2.5; CI 95 [1–6.1]; P=0.039). Compared with OLT grafts, long-term HT graft survival rates were not different (HR=1.7; CI 95 [0.96–3.1]; P=0.066), while patient survival rates were lower in the HT group (HR=4.6; CI 95 [2–11]; P<0.001). CONCLUSIONS: Compared to OLT, HT significantly reduces patient survival. Given the poor survival results of CPA, the indication deserves to be limited in the context of organ shortage and RPA should be preferred when HT is needed.