79 Systematic Review and Meta-Analysis of the Role of Aorto-Hepatic Conduits in Liver Transplant: Known Knowns and Known Unknowns

Abstract Background Aorto-hepatic conduits (AHCs) are used for liver allograft revascularisation when the native hepatic artery is unusable. Studies suggest that outcomes with AHCs are inferior compared to native hepatic artery inflow. Aims This systematic review and meta-analysis assessed the outcomes based on different inflow sites for AHCs. Methods The review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) standards (PROSPERO ID: CRD42024545810). Results Fourteen studies included 32,486 deceased donor liver transplants, of which 1,136 (3.5%) required AHCs. The most common indications were poor arterial flow, intimal dissections, and hepatic artery thrombosis (HAT). Among the AHCs, 18.2% were supra-coeliac (SC), 65% were infra-renal (IR), and 2.2% used iliac artery conduits. Pooled analysis showed comparable demographics across groups. The median follow-up ranged from 18 to 52 months. No significant differences were found between SC and IR conduits in early (OR 0.94; P = 0.86) or late occlusions (OR 0.46; P = 0.15), early allograft dysfunction (OR 0.82; P = 0.51), biliary complications (OR 1.10; P = 0.68), renal replacement therapy (OR 1.12; P = 0.62), or major surgical complications (OR 1.06; P = 0.79). Median graft occlusion occurred at 142 days (range: 13–3,313). One-year graft survival rates were 77%–81.1% (SC) and 66%–79.1% (IR), with five-year rates at 53.9%–67% (SC) and 50%–56% (IR). Conclusion There were no significant differences in early or late outcomes between SC and IR AHCs, though IR conduits showed a trend toward higher late occlusion rates.