Extra anatomic hepatic artery reconstruction in deceased donor liver transplantation – Feasibility and outcome

Vijay, Kapileshwer; Naidu, C. S.; Rao, Pankaj P.; Sharma, Sanjay; Godara, Rajesh; Vijayvergia, Varunika

doi:10.1016/j.ijt.2013.01.002

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…In our cohort, the overall hepatic artery occlusion rate was 12% with 8% accounting for HAT that compares to the reported figures in the literature. In accordance with other reports, we found the highest occlusion rate in the AHC group followed by the AR group. Another important finding of our study was the observation that interventions for partial occlusion did not lead to higher patency (primary‐assisted patency).…”

Section: Discussionsupporting

confidence: 93%

Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

Oberkofler¹,

Reese²,

Raptis³

et al. 2018

Liver Transpl

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Although the type of hepatic artery revascularization technique is known to have an impact on patency rates, independent perioperative risk factors on patient outcomes are poorly defined. All consecutive adult patients undergoing cadaveric liver transplantation (n = 361) from July 2007 to June 2016 in a single institution were analyzed. Primary outcomes were early (<30 days) hepatic artery occlusion and primary hepatic artery patency rate. A multivariate model was used to identify independent risk factors for occlusion and the need of arterial conduit, as well as their impact on graft and patient survival. Arterial revascularization without additional reconstruction (end-to-end arterial anastomosis [AA]) was performed in 77% (n = 279), arterial reconstruction (AR) in 15% (n = 53), and aortohepatic conduit (AHC) in 8% (n = 29) of patients. AHC had the highest mean intraoperative flow (275 mL/minute; P = 0.02) compared with AA (250 mL/minute) and AR (200 mL/minute; P = 0.02). There were 43 recipients (12%) who had an occlusive event with successful revascularization in 20 (47%) recipients. One-year primary patency rates of AA, AR, and AHC were 97%, 88%, and 74%, respectively. Aortic calcification had an impact on early occlusion. AR (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.26-10.75; P = 0.02) and AHC (OR, 6.21; 95% CI, 2.02-18.87; P = 0.001) were independent risk factors for early occlusion. Dyslipidemia additionally independently contributed to early occlusion (OR, 2.74; 95% CI, 0.96-7.87; P = 0.06). The 1- and 5-year graft survival rates were 83% and 70% for AA, 75% and 69% for AR, and 59% and 50% for AHC (P = 0.004), respectively. In conclusion, arterial patency is primarily determined by the type of vascular reconstruction rather than patient or disease characteristics. The preoperative lipid status is an independent risk factor for early occlusion, whereas overall occlusion is only based on the performed vascular reconstruction, which is also associated with reduced graft and patient survival. Liver Transplantation 24 790-802 2018 AASLD.

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Section: Discussionsupporting

confidence: 93%

Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

Oberkofler¹,

Reese²,

Raptis³

et al. 2018

Liver Transpl

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“…Different techniques have been reported in literature to deal with the complication of recipient hepatic artery intimal dissection, like the use of an extra-anatomic jump graft from Aorta with a conduit [4,5]. The use of saphenous vein graft as a conduit, is a common technique used for giving arterial inflow to the graft [6].…”

Section: Discussionmentioning

confidence: 99%

“…Selecting an appropriate vessel for hepatic arterial reconstruction and applying microsurgical techniques are crucial steps in reducing the risk of hepatic artery thrombosis during living donor liver transplantation [3]. To overcome this complication of Recipient hepatic artery dissection, various techniques have been described by different authors like using of an extra-anatomic jump graft with a conduit [4,5]. Here, in this case report we are describing a rare technique of utilization of transposed recipient splenic artery for graft arterial inflow in spite of using extraanatomic jump graft with a conduit, in a recipient with dissected hepatic artery.…”

Section: Introductionmentioning

confidence: 99%

Providing Arterial Supply to the Liver Graft with Recipient Splenic Artery in Living Donor Liver Transplantation: Case Report

Uddin¹,

Izzu²,

Ullah³

et al. 2020

TCR

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Hepatic arterial reconstruction is an important step in graft implantation in liver transplant procedure. Hepatic arterial anastomosis always demands meticulous and highly skilled surgical techniques to provide adequate blood supply to the graft. Hepatic arterial intimal dissection in liver transplantation is although a rare but documented complication, with incidence of less than 5%, but having dreadful complications. To overcome this complication of Recipient hepatic artery dissection, various techniques have been described by different authors. Here, in this case report we are describing technique of utilization of transposed recipient splenic artery for graft arterial inflow where native hepatic artery was dissected up to common hepatic artery. Post-operative recovery was uneventful and on follow up, patient was absolutely fine. So, recipient splenic artery is a safe alternative option in such complex situations for providing arterial blood flow to the graft and moreover it avoids the burden of extra anastomosis which is required in conduit technique.

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“…3 But due to the non-availability of this option in LDLT, various transposed arteries like the left gastric artery (LGA), right gastric epiploic artery (RGE), gastroduodenal artery (GDA), splenic artery (SA), or even saphenous vein conduit from aorta had been reported for HAR with variable results. [3][4][5][6] Various extra-anatomic HAR techniques are practiced when native recipient HA is not suitable, but still, no consensus is achieved on a single technique. Few authors have reported the outcome of SA utilization for HAR in DDLT.…”

Section: A H E a D O F P R I N Tmentioning

confidence: 99%

Splenic artery transposition for hepatic arterial supply in living donor liver transplantation

et al. 2022

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Objective: To determine the safety and outcome of splenic artery(SA) transposition in extra-anatomic hepatic arterial reconstruction (HAR) in living donor liver transplantation(LDLT). Methods: We retrospectively compared the outcome of the ten liver recipients who underwent HAR with the transposed splenic artery (SA group) with a matched cohort of 40 recipients who underwent HAR with the standard hepatic artery (HA group) between March, 2019 and December, 2020 at liver transplantation department, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Pakistan. The comparison of recipients’ and donor demographics, operative and graft characteristics, post-operative labs, Doppler ultrasound(USG) findings, and complications, along with 30-day mortality, and 1-year survival were reported for both groups. Results: The mean age of patients in the SA group was 42.80±7.510 and in the HA group was 43.73±8.171 years. The common indication of LDLT was viral hepatitis in both groups. The operative duration was longer in the SA group (597.50±41.3156 min) than in the HA group (530.75±66.502 min) with a significant p-value= 0.004. Similarly, blood loss was also more in the SA group (1635±226.139 ml) than in the HA group (1477.50±270.316 ml) (p-value= 0.096). The incidence of biliary and vascular complications, early allograft dysfunction, acute cellular rejection, 30-day mortality, and 1-year survival were comparable in both groups. Post-operatively splenectomy was not needed in any SA group recipients. Conclusion: The SA is easily approachable, suitable, and safe for HAR in the difficult situation of hepatic arterial flow inadequacy during LDLT due to its appropriate length, and good blood flow. doi: https://doi.org/10.12669/pjms.39.1.6351 How to cite this: Ullah K, Dogar AW, Shams-ud-Din, Bilal H. Splenic artery transposition for hepatic arterial supply in living donor liver transplantation. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6351 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Extra anatomic hepatic artery reconstruction in deceased donor liver transplantation – Feasibility and outcome

Cited by 6 publications

References 6 publications

Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

Providing Arterial Supply to the Liver Graft with Recipient Splenic Artery in Living Donor Liver Transplantation: Case Report

Splenic artery transposition for hepatic arterial supply in living donor liver transplantation

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