ABSTRACT Background and Aims The aging of liver donors and transplant candidates, along with the growing prevalence of metabolic comorbidities, may lead to hepatic artery atherosclerosis. Since the biliary epithelium relies on arterial flow, hepatic artery atherosclerosis could increase the risk of biliary strictures after liver transplantation. Methods Cohort study including all adult patients undergoing liver transplantation in a single institution between 2012 and 2023 who had a blinded pathological evaluation of the donor and recipient hepatic artery to diagnose perianastomotic atherosclerosis. Cox regression analyses were performed to identify risk factors for biliary strictures. Results Among 320 patients, 63 (19.6%) developed biliary complications after a median follow‐up of 44 months (IQR 17–71). The incidence of biliary strictures was 14.3% in 24 months. Patients with and without biliary strictures were comparable in terms of age, sex, liver transplantation indication, and cardiovascular risk factors. Patients with hepatic artery atherosclerosis either in the donor or in the recipient segments had a higher risk of biliary strictures in 24 months (17.6% vs. 9.8%, p = 0.048). Donation after circulatory death grafts were associated with a higher risk of biliary strictures compared with brain‐dead donors (23.6% vs. 12.5%; p = 0.031). In the multivariable analysis, hepatic artery atherosclerosis (HR = 2.51; 95% CI 1.15–5.47; p = 0.021) and donation after circulatory death grafts (HR = 3.36; 95% CI 1.02–11.11; p = 0.047) were independent predictors of biliary strictures after liver transplantation. Conclusions Perianastomotic hepatic artery atherosclerosis is highly prevalent after deceased donor liver transplantation and may increase the risk of biliary strictures irrespective of modality of donation.
Alañón‐Martínez et al. (2026) studied this question.