Single Arterial Anastomosis in Case of the Presence of Multiple Hepatic Arteries and the Presence of Pulsatile Back Flow is Safe in Living Donor Liver Transplantation

Lee, Seung Eun; Suh, Kyung Suk; Yi, Nam Joon; Kwon, Choon Hyuck; Cho, Jai Young; Minn, Kyung Won; Lee, Kuhn Uk

Abstract

PURPOSE
The aim of this study is to analyze the outcome of a single hepatic artery anastomosis among multiple graft arteries in living donor liver transplantation.
METHODS
A total of 153 LDLTs were performed at Seoul National University Hospital between January 1999 and December 2002. Thirty four cases (22.2%) of grafts were fed by multiple hepatic arteries. Twenty cases which were fed by left hepatic artery and middle hepatic artery, one intraoperative expired case and one case which was performed two hepatic arteries anastomosis were excluded in our study. Eight cases with two left hepatic arteries and 4 cases with two right hepatic arteries were reviewed. Hepatic artery anastomosis was carried out under operating microscope using interrupted Carrel's technique. In case of the presence of pulsatile back- flow after single hepatic artery anastomosis, the other hepatic artery was ligated. The median period of follow-up was 35 (26~58) months.
RESULTS
There was no mortality due to complications associated with hepatic artery. In 11 cases, the adequate blood flow was verified daily for seven days after transplantation by means of Doppler ultrasonography. In 7 cases, intrahepatic arteries of donors seen on the preoperative CT aniography were confirmed at the same site on the postoperative CT angiography of recipients. Reoperation was performed for a one-year old child due to hepatic artery obstruction at the 11th postoperative day and she experienced acute rejection twice and steroid pulse therapy was performed. But she expired at the 107th postoperative day due to graft failure despite intact hepatic arterial flow on liver doppler sonography.
CONCLUSION
Single hepatic artery anastomosis among multiple graft arteries had no complication. Thus single hepatic artery anastomosis among multiple graft arteries when pulsatile back flow existed, is safe and convenient method.