Hepatic arterial complications in adult living donor liver transplant recipients: a single‐center experience of 673 cases

Iida, Takuya; Kaido, Toshimi; Yagi, Shintaro; Hori, Tomohide; Uchida, Yoichiro; Jobara, Kanta; Tanaka, Hiroyuki; Sakamoto, Seisuke; Kasahara, Mureo; Ogawa, Kohei; Ogura, Yasuhiro; Mori, Akira; Üemoto, Shinji

doi:10.1111/ctr.12412

Cited by 44 publications

(26 citation statements)

References 19 publications

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“…57,65,66 Other studies have demonstrated that extra-anatomic anastomosis was the only multivariate factor independently associated with hepatic artery complications in the living donor transplant recipient. 67 HAT in the transplantation literature usually is discovered on serial Doppler ultrasounds, which are an integral component of postoperative care for the patient after transplantation; however, computed tomography (CT) scans also may provide information on HAT. As there are no large series of hepatic artery resection in liver resection, it is difficult to definitively identify relevant risk factors in this population of patients.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Interventional radiology-based procedures, such as angioplasty, can be considered; however, urgent surgical thrombectomy may be required to reestablish flow. 67 PVT can be managed in various ways, as reviewed by Thomas and Ahmad 68 in 2010. Anticoagulation with intravenous heparin followed by long-term warfarin has reduced the risk of thrombotic events and promoted the recanalization of the vein.…”

Section: Managementmentioning

confidence: 99%

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Complications Following Hepatectomy

Russell

2015

Surgical Oncology Clinics of North America

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Section: Risk Factorsmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Complications Following Hepatectomy

Russell

2015

Surgical Oncology Clinics of North America

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“…Hepatic artery thrombosis (HAT) is an uncommon complication after liver transplantation with serious clinical implications including graft loss and increased recipient mortality . Surgical risk factors including organ cold ischemia time (CIT), surgical technique, delay in reperfusion, and anatomic abnormalities all likely play a role in outcomes .…”

Section: Introductionmentioning

confidence: 99%

Liver transplant recipients with portal vein thrombosis receiving an organ from a high-risk donor are at an increased risk for graft loss due to hepatic artery thrombosis

et al. 2016

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Problem We hypothesize that recipients with pre-transplant portal vein thrombosis (PVT) receiving organs from high-risk donors (HRD) are at increased risk of HAT. Methods Data on all liver transplants in the United States from February 2002-March 2015 were analyzed. Recipients were sorted into two groups: those with PVT and those without. HRDs were defined by Donor Risk Index (DRI) >1.7. Multivariable logistic regression models were constructed to assess independent risk factors for HAT with resultant graft loss ≤90 days from transplantation. Results 60,404 candidates underwent liver transplantation; of those recipients, 623 (1.0%) had HAT, of which 66.0% (n=411) received organs from HRDs compared to 49.3% (n=29,473) in recipients without HAT (p<0.001). 2,250 (3.7%) recipients had pre-transplantation PVT and received organs from HRDs. On adjusted multivariable analysis, PVT with a HRD organ was the most significant independent risk factor (OR 3.56, 95% CI 2.52–5.02, p<0.001) for the development of HAT. Conclusions Candidates with pre-transplant PVT who receive an organ from a HRD are at the highest risk for post-operative HAT independent of other measurable factors. Recipients with pre-transplant PVT would benefit from careful donor selection and possibly anticoagulation perioperatively.

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“…The hepatic arteries that are reconstructed in LDLT are usually thinner in diameter and have a shorter stalk than those in deceased‐donor liver transplantation—especially when left hepatic grafts are used. Many surgeons prefer to reconstruct hepatic arteries in LDLT using a microvascular surgical technique . As shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The recently reported incidence of hepatic artery-related complication at high volume centers for AALDLT ranged from 1.6% to 6.5%. 5,[13][14][15][16][17] The hepatic arteries that are reconstructed in LDLT are usually thinner in diameter and have a shorter stalk than those in deceased-donor liver transplantation-especially when left hepatic grafts are used. Many surgeons prefer to reconstruct hepatic arteries in LDLT using a microvascular surgical technique.…”

Section: Discussionmentioning

confidence: 99%

The use of left grafts with a replaced or accessory left hepatic artery in adult‐to‐adult living donor liver transplantation: analyses of donor and recipient outcomes

Uchiyama

Yoshizumi

Ikegami

et al. 2016

Clinical Transplantation

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In living donor liver transplantation (LDLT), a left hepatic graft occasionally includes a replaced or accessory left hepatic artery (LHA). The procuring of such grafts requires extensive dissection along the lesser curvature of the stomach to elongate the replaced or accessory LHA on the donor side. On the recipient side, complicated arterial reconstruction is often necessary to use such grafts. We retrospectively reviewed the medical records of 206 adult recipients who underwent LDLT and their respective donors. The recipients and donors were divided into two groups according to the presence of the replaced or accessory LHA. Twenty-five grafts included a replaced or accessory LHA. Only one hepatic artery-related complication was observed in the current series, in which a pseudoaneurysm arose at the site of anastomosis between the donor accessory LHA and the recipient LHA. There was no increase in the incidence of postoperative complications in the donors with a replaced or accessory LHA in comparison with the donors without these arteries. The use of left hepatic grafts that included a replaced LHA or accessory LHA did not have any negative impact on the outcomes on either the donor or the recipient side.

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Hepatic arterial complications in adult living donor liver transplant recipients: a single‐center experience of 673 cases

Abstract: Because hepatic arterial complications after LDLT are associated with poor patient survival, early diagnosis and immediate treatment are crucial. The anatomical anastomosis may be the first choice for the hepatic arterial reconstruction to the extent possible.

Cited by 44 publications

References 19 publications

Complications Following Hepatectomy

Complications Following Hepatectomy

Liver transplant recipients with portal vein thrombosis receiving an organ from a high-risk donor are at an increased risk for graft loss due to hepatic artery thrombosis

The use of left grafts with a replaced or accessory left hepatic artery in adult‐to‐adult living donor liver transplantation: analyses of donor and recipient outcomes

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