J Korean Soc Transplant.  2010 Dec;24(4):284-288.

Experience with Microsurgical Reconstruction of the Hepatic Artery in 100 Living Donor Liver Transplantation

• Kim MS
• Han YS
• Choi DL
• Kim JD

Abstract

BACKGROUND
In living-donor-liver transplantation, microsurgical reconstruction of the hepatic artery is essential and this is challenging issue because of the small diameter of the vessels in the partial liver graft. We present our experiences for hepatic arterial reconstruction with focusing on the technical aspects.
METHODS
Methods: From May 2005 through December 2009, 100 patients received right hemiliver grafts (n=86) or left hemiliver grafts (n=14). Hepatic artery anastomosis was performed using microsurgical techniques. All the anastomoses were successfully accomplished by a single transplantation surgeon who worked under a microscope. Our classical method for arterial reconstruction in living donor liver transplantation (LDLT) consists of the interrupted end-to-end anastomosis between the hepatic artery of the graft and the most accessible hepatic artery of the recipient.
RESULTS
We could confirm the patency of the reconstructed artery during the early post-transplantation period. Ninety five patients had the hepatic arteries reconstructed by the conventional twist technique. We used the right gastroepiploic artery in one patient because of the intimal dissection of the hepatic artery, and we used an interposition graft, with using the greater saphenous vein, in 2 patients. technical complication was occurred in only 1 patient. The hepatic artery pseudoaneurysm was confirmed at 4 weeks after transplantation. Arterial steal syndrome was detected in 2 patients and this was treated by angiographic techniques.
CONCLUSIONS
Meticulous intraoperative microsurgical techniques and careful postoperative evaluation are very important in the hepatic artery reconstruction of LDLT. An experienced transplantation microscopy surgeon is also needed for creating safe anastomosis and achieving a lower complication rate.

Keyword

Living donors; Liver transplantation; Hepatic artery; Thrombosis; Microsurgery; Reconstructive surgical procedures

MeSH Terms

Aneurysm, False
Arteries
Gastroepiploic Artery
Hepatic Artery
Humans
Liver
Liver Transplantation
Living Donors
Microscopy
Microsurgery
Reconstructive Surgical Procedures
Saphenous Vein
Thrombosis
Transplants

Figure

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  Fig. 1. Interposition graft. Interposition graft using greater saphenous vein between graft hepatic artery and common hepatic artery.

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  Fig. 2. Pseudoaneurysm of hepatic artery anastomosis site. (A) CT finding. (B) Angiographic finding.

Reference

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