Plastic surgery in liver transplantation

Chiang, Yuan‐Cheng; Chen, C.L; Chen, Y.S; Liu, P.P; Wang, C.C; Eng, Hock‐Liew; Huang, Tung‐Liang; Cheng, Y.-F.; Goto, Shigeru; Jawan, Bruno; Cheung, H.K

doi:10.1016/s0041-1345(98)00981-6

Cited by 10 publications

(11 citation statements)

References 7 publications

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“…While it is thought that the major risk for HAT is a direct result of local trauma to the vessels during anastomosis, our results suggest that understanding the pro‐thrombotic state in the early days post‐LT and correcting it appropriately appears to be the intervention that has made the most significant difference in preventing HAT. Thus, both the use of microsurgical techniques and the appropriate management of coagulopathy are essential in minimizing risk of HAT …”

Section: Discussionmentioning

confidence: 99%

“…The advent of split liver grafts has eased the pressure of donor organ shortages but has contributed to increased technical difficulties and further increased the risk of HAT . Attempts to reduce the incidence of HAT using microsurgical techniques either with or without the use of an operating microscope have shown to be of some but not consistent benefit …”

Section: Introductionmentioning

confidence: 99%

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Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol

Ziaziaris

Darani

Holland

et al. 2017

Pediatric Transplantation

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We aimed to assess the incidence of HAT over three eras following implementation of microvascular techniques and a customized anticoagulation protocol in a predominantly cadaveric split liver transplant program. We retrospectively reviewed pediatric liver transplants performed between April 1986 and 2016 and analyzed the incidence HAT over three eras. In E1, 1986-2008, each patient received a standard dose of 5 U/kg/h of heparin and coagulation profiles normalized passively. In E2, 2008-2012, microvascular techniques were introduced. In E3, 2012-2016, in addition, a customized anticoagulation protocol was introduced which included replacement of antithrombin 3, protein C and S, and early heparinization. A total of 317 liver transplants were completed during the study period, with a median age of 31.7 months. In E1, 22% of grafts were cadaveric in situ split grafts, while the second and third eras used split grafts in 59.0% and 64.9% of cases, respectively. HAT occurred in 9.5% in the first era, 11.5% (P=.661) in the second, and dropped to 1.8% in the third era (P=.043). A routine anticoagulation protocol has significantly reduced the incidence of HAT post-liver transplantation in children in a predominantly cadaveric in situ split liver transplant program.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol

Ziaziaris

Darani

Holland

et al. 2017

Pediatric Transplantation

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“…Using smooth manual bagging technique instead of mechanical ventilation has been suggested. 14,15 In our practice, the anesthesiologists decrease the tidal volume to 300-400 mL/min without manual bagging during the arterial anastomosis. The suturing of the hepatic arteries may be adjusted according to the rhythmic chest wall upper and down movement.…”

Section: Discussionmentioning

confidence: 99%

“…11 The local adverse factors are the availabil-ity of only one HA which is short in length and diameter, anatomical variations of the right/left lobe in the donor, impaired quality and size difference of the allograft vessels and deep location of the vessels. 3,4 To manage most of these challenges and to increase the success rate, some surgeons advocate the use of microsurgical techniques [12][13][14][15] while others do not. 4 The objective of this study was to investigate the arterial complications of partial liver transplantation using microsurgical technique.…”

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confidence: 99%

Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation

et al. 2006

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Hepatic artery thrombosis is the most common technical complication in liver transplantation. The objective of this study was to investigate the arterial complications of partial liver transplantation using microsurgical technique. At a period of 31-months, we participated in a total of 42 right lobes, 7 left lobes, and 1 whole-liver liver transplantations from cadaveric (n = 20) or living (n = 30) donors. Hepatic artery anastomosis was performed using microsurgical techniques. All anastomoses were accomplished successfully. Fifteen patients expired postoperatively and 35 hepatic artery anastomoses remained patent at a mean follow-up period of 10.6 +/- 8.4 months. The mean diameters of the donor and recipient hepatic arteries were 2.9 +/- 1.2 mm and 3.2 +/- 1.1 mm, respectively. Specific technical challenges were encountered during operation in eight cases (16%). We have found that microsurgical techniques are not only useful for a superior anastomosis but also reliable to adapt to vascular anomalies with less arterial complications. complications.

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“…Intimal dissection (ID) of the recipient HA may be recognized only at the time of the transplant operation and result in HA occlusion 4. Microsurgical HA reconstruction is known to be superior to the conventional method in reconstructing the HA in living donor liver transplantation (LDLT) 5–13. The gross pathological changes in ID can be found easily under microscope magnification.…”

mentioning

confidence: 99%

Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: An intraoperative problem in adult living donor liver transplantation

Lin¹,

Chiang²,

Chen³

et al. 2009

Liver Transpl

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The objective of this study was to describe the relationship between intimal dissection (ID) in the recipient hepatic artery (HA) and transarterial embolization (TAE) and highlight the reconstructive methods for the different types of ID encountered in living donor liver transplantation (LDLT). Fifty-four patients with hepatocellular carcinoma underwent LDLT. ID was classified as mild, moderate, or severe, and this classification was based on the extent of intimal injury. Mild, moderate, or severe ID were defined as ID that was less than one-quarter of the circumference of the HA, had reached one-half of the circumference of the HA, or was more than one-half of the circumference of the HA or involved the entire vessel wall, respectively. The reconstructive methods were based on the severity of ID encountered. Forty patients underwent TAE before LDLT, and 23 of these patients (57.5%) had ID. Nine patients had mild ID, 6 had moderate ID, and 8 had severe ID. In the 14 patients who did not undergo TAE, 4 had ID (28.6%; 3 mild and 1 severe). The other 10 patients (71.4%) had normal HA. In mild and moderate ID, the native HA was used after trimming of the HA until a healthy segment was encountered. In severe ID, the HA was reconstructed with alternative vessels. Two HA thromboses occurred postoperatively. TAE increased the risk of developing ID 2-fold. There was no graft loss or mortality in this series due to HA complications. In conclusion, ID of the HA is associated with pretransplant TAE among hepatocellular carcinoma patients undergoing LDLT. Intraoperative recognition of this complication and trimming until good vessel quality is encountered or using alternative vessels are important.

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Plastic surgery in liver transplantation

Cited by 10 publications

References 7 publications

Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol

Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol

Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation

Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: An intraoperative problem in adult living donor liver transplantation

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