Partial dearterialization of the liver allograft

Yanaga, Katsuhiko; Tzakis, A; Starzl, TE

doi:10.1007/bf00366963

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…However, Yanaga et al [10] reported the clinical course of five patients with partial dearterialization of their hepatic allografts. One patient died and three others suffered serious morbidity as a direct or indirect result of this complication.…”

Section: Discussionmentioning

confidence: 99%

“…One patient died and three others suffered serious morbidity as a direct or indirect result of this complication. They concluded that partial dearterialization of the liver allograft results in a serious and potentially life-threatening complication for which preservation of the complete hepatic arterial supply is important, even if this requires reconstruction of the aberrant vessels [10]. In addition, hepatic artery ligation can lead to liver infarction and subsequent liver abscess [10].…”

Section: Discussionmentioning

confidence: 99%

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Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft

Byun

Suh

2012

J Korean Surg Soc

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It is important that extrahepatic arteries are identified precisely at the time of graft procurement. We present a case where the accessory right hepatic artery of the liver was ligated leading to postoperative liver abscess formation in the liver graft. A forty-seven-year-old female patient diagnosed with liver cirrhosis underwent orthotopic cadaveric liver transplantation due to altered mentality. The donor graft showed a variant of the hepatic artery anatomy where an accessory right hepatic artery arose from the superior mesenteric artery. This artery was accidentally transected during procurement. Since the back bleeding test using perfusion fluid was good, the artery was ligated. Postoperative abdominal computed tomography scan revealed a 6 cm low attenuating lesion in the liver. The patient underwent conservative treatment. We believe that even small accessory arteries (1 to 2 mm) should be reconstructed whenever possible to avoid postoperative complications such as liver abscess.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft

Byun

Suh

2012

J Korean Surg Soc

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“…The liver has fine intrahepatic arterial networks [17], so it is possible that reconstructing only one HA might maintain the minimum arterial supply for a hepatic graft to survive [18,19]. However, we believe that a hepatic graft would be in a condition of relative arterial ischemia if the HAs on the graft were incompletely reconstructed [20]. In fact, we observed a high incidence of anastomotic biliary stricture in LDLT recipients who underwent incomplete HA reconstruction [21,22].…”

Section: Hepatic Artery Reconstruction In Living Donor Liver Transplamentioning

confidence: 84%

Expanding the applications of microvascular surgical techniques to digestive surgeries: a technical review

et al. 2011

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In living donor liver transplantation (LDLT), it is considered safer to reconstruct hepatic arteries (HAs) under a microscope than under conventional loupe magnification, because graft HA stumps are generally thin and short with an average diameter of approximately 2 mm. We first applied microvascular surgical techniques to HA reconstruction for LDLT in 1996. In most cases, we use a disposable double-clip to secure the graft and recipient arteries, and interrupted 8-0 nonabsorbable monofilament sutures. We next started performing resection and reconstruction of the right HA in a surgery for hilar cholangioma using the same technique as in LDLT. Lately, we have started applying microvascular surgical techniques to various digestive surgeries; namely, supercharge and superdrainage in esophageal surgery, vascular reconstruction in free jejunal interposition grafts for cervical esophageal cancer, resection and reconstruction of spontaneous HA aneurysms, jejunal artery reconstruction for spontaneous superior mesenteric artery dissections, and so forth. Mastering this technique is time consuming. However, once a surgeon masters the technique it has almost unlimited applications, and most vital vessels can be safely reconstructed using this method. We herein provide a technical review of the application of microvascular surgical techniques for various digestive surgeries.

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“…[6][7][8] Indeed, in our policy such a parameter is not considered sufficient for decision making. In DDLT, a selective reconstruction policy for aHA has been much less explored, probably due to early negative experiences in the setting of unselected partial graft arterialization [24] or due to the inherent longer cold ischemia time and lower graft quality associated with DDLT, when compared with LDLT. In 2018, Montalti et al [2] reported on a single-center experience with a selective aLHA ligation.…”

Section: Variablesmentioning

confidence: 99%

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

et al. 2022

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In liver transplantation (LT), graft aberrant hepatic arteries (aHAs) frequently require complex arterial reconstructions, potentially increasing the risk of post-operative complications. However, intrahepatic hilar arterial shunts are physiologically present and may allow selective aHA ligation. Thus, we performed a retrospective study from a single-center cohort of 618 deceased donor LTs where a selective reconstruction policy of aHAs was prospectively applied. In the presence of any aHA, the vessel with the largest caliber was first reconstructed. In case of adequate bilobar arterial perfusion assessed on intraparenchymal Doppler ultrasound, the remnant vessel was ligated; otherwise, it was reconstructed. Consequently, outcomes of three patient groups were compared: the "no aHAs" group (n = 499), the "reconstructed aHA" group (n = 25), and the "ligated aHA" group (n = 94). Primary endpoint was rate of biliary complications. Only 38.4% of right aHAs and 3.1% of left aHAs were reconstructed. Rates of biliary complications in the no aHA, reconstructed aHA, and ligated aHA groups were 23.4%, 28%, and 20.2% (p = 0.667), respectively. The prevalence rates of primary non-function (p = 0.534), early allograft dysfunction (p = 0.832), and arterial complications (p = 0.271), as well as patient survival (p = 0.266) were comparable among the three groups. Retransplantation rates were 3.8%, 4%, and 5.3% (p = 0.685), respectively. In conclusion, a selective reconstruction policy of aHAs based on Doppler assessment of bilobar intraparenchymal arterial flow did not increase post-operative morbidity and avoided unnecessary and complex arterial reconstructions.

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Partial dearterialization of the liver allograft

Cited by 7 publications

References 11 publications

Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft

Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft

Expanding the applications of microvascular surgical techniques to digestive surgeries: a technical review

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

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