The type of arterial reconstruction used for arterial anastomosis during primary liver transplantation has an impact on the occurrence of early HAT. The use of a long graft artery is an independent risk factor of early HAT. Thereby, we recommend the use of a short graft artery with a direct path when feasible to reduce the occurrence of early HAT after primary liver transplantation.

Recipient hepatectomy is a challenging liver transplantation (LT) procedure that has life-threatening complications. The current predictive mortality clinic-biological scores (Child/Model for End-Stage Liver Disease [MELD]) do not take into consideration the recipient's liver anatomy. The aim of this study was to evaluate the impact of the dorsal sector anatomy of a cirrhotic liver on the morbidity/mortality rates of hepatectomy. A multicenter retrospective study (clinic-biological and morphologic) was performed from 2013 to 2014. The degree of encirclement of the inferior vena cava (IVC) by the dorsal sector of the liver was measured. The study population included 320 patients. Seventyfour (23%) patients had complete IVC encirclement. A correlation (P 5 0.01) has been reported between the existence of a circular dorsal sector and the number of transfusions during LT (4 packed red blood cell [PRBC] transfusions in the group without IVC versus 7 PRBC transfusions in the other group). The existence of such anatomy increases the relative risk of early reoperation for IVC bleeding by 31% (P 5 0.05). There is a correlation between alcoholic cirrhosis and dorsal-sector hypertrophy (126 cc versus 147.5 cc; P 5 0.05). Concerning surgical time, we found no significant between-group differences. Compared to the severity of cirrhosis, an inverse correlation was observed between the MELD and Child scores and the dorsal sector hypertrophy (P < 0.001). No significant difference in terms of transfusion was found between the temporary portocaval shunt group (n 5 168) and the other group (n 5 152). The presence of a circular sector is associated with an increased risk of hemorrhage during hepatectomy, as well as an immediate postoperative risk of reoperation.Liver Transplantation 22 906-913, 2016 AASLD. The first step in liver transplantation (LT) consists of a full hepatectomy. Initial LT techniques are required to replace the recipient's inferior vena cava (IVC) at the retrohepatic part. (1) Reconstruction techniques allowing for the preservation of the IVC have been described. (2) The hepatectomy represents the most difficult time during surgery, with life-threatening complications related to the risk of massive hemorrhage. In addition, the difficulty of hepatectomy is hard to define and to anticipate. There is no preoperative score that considers the morphological data of the native liver to anticipate hepatectomy difficulty; the existence of hypertrophy in the dorsal sector has been quoted by many authors, but there are few analyses of the surgical impact. The difficulty of hepatectomy seems to be related to the release of the IVC, and, thus, it depends on the hepatic segment in contact with the vein: the involved segments are segment I (S1) and segment IX (S9), according to Couinaud, (3) and anatomical variations of this hepatic sector are important.

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