Should all hepatic arterial branches be reconstructed in living-related liver transplantation?

Ikegami, Toshihiko; Kawasaki, Seiji; Matsunami, Hidetoshi; Nakazawa, Yūichi; Miyagawa, Shinichi; Furuta, S; Iwanaka, Tadashi; Makuuchi, Masatoshi

doi:10.1016/s0039-6060(96)80144-9

Cited by 89 publications

(64 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Replaced hepatic arteries are anomalies that are easily managed; in contrast, the presence of accessory arteries might result in reconstructions of double arteries that, because of their small diameters, are the cause of an increased rate of arterial thrombosis despite the use of refined suture techniques with magnifying glasses and microsurgery 13,14 ; the concept of mandatory reconstructions when double arteries are present is, however, being revisited based on the observations about intrahepatic arterial flow in the livingdonor transplantation setting. 17 Types 2, 3, and 4, present in 21% of our cases, are favorable variants to obtain a split liver or a right hepatic lobe from a living donor, with a long and independent artery that is perfect for arterial anastomosis. Importantly, a double artery is found in 1.5% and in 5% of right or left hepatic lobes, respectively.…”

Section: Discussionmentioning

confidence: 82%

“…Although classically it was considered that the hepatic arterial vascularization is terminal and that there are no intrahepatic communications between the different branches, 3,16 more recent data, particularly that originating from the living donor experience, has challenged this concept. 17 We considered it important to identify all the hepatic arteries and to classify them as "accessory" or "replaced." Indeed, replaced arteries must be always preserved; in contrast, accessory arteries do not necessarily need to be reconstructed if there is adequate backflow after the anastomosis of the other branch or if arterial flow in all the segments is demonstrated by intraoperative Doppler ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

et al. 2007

View full text Add to dashboard Cite

The aim of this study is to contribute our experience to the knowledge of the anatomic variations of the hepatic arterial supply. The surgical anatomy of the extrahepatic arterial vascularization was investigated prospectively in 1,081 donor cadaveric livers, transplanted at La Fe University Hospital from January 1991 to August 2004. The vascular anatomy of the hepatic grafts was classified according to Michels description (Am J Surg 1966;112:337-347) plus 2 variations. Anatomical variants of the classical pattern were detected in 30% of the livers (n ϭ 320). The most common variant was a replaced left artery arising from the left gastric artery (9.7%) followed by a replaced right hepatic artery arising from the superior mesenteric artery (7.8%). In conclusion, the information about the different hepatic arterial patterns can help in reducing the risks of iatrogenic complications, which in turn may result in better outcomes not only following surgical interventions but also in the context of radiological treatments. Knowledge of hepatic arterial vascularization has a significant relevance for the daily practice of a wide range of practitioners including not only surgeons specialized in the hepato-biliary-pancreatic area, but also general surgeons and radiologists, mainly those who are dedicated to interventional radiologic treatments.In the last few years, substantial improvements have been achieved in the surgical and/or radiological treatment of benign and malignant liver, pancreatic, and biliary diseases. With laparoscopic surgery the need has arisen for exact descriptions of the hepatic vascularization to avoid iatrogenic vascular lesions.In the setting of liver transplantation, the most effective approach to reduce the dropout rate on the waiting lists is to expand the number of available livers. Several strategies including living donors and split livers have been developed for this purpose. These are extremely complex techniques in which the exact knowledge of the arterial anatomy is a required step to plan the best resection as well as to minimize the risks of morbidity.The patterns of hepatic arterial supply are not constant. The usual anatomy of the hepatic arterial vascularization is a common hepatic artery arising from the celiac axis, accounting for 25 to 75% of the cases. 1 In the variant patterns, the hepatic lobes receive arterial flow through branches coming from the superior mesenteric artery, left gastric artery, or, rarely, from other arterial trunks. 2 Since Michels 3 published his first report, several studies have reported not only common and rare hepatic artery variants, but also different classifications. These studies are based on angiographic data and autopsy dissections, and mainly derive from surgery and transplantation literature. [4][5][6][7][8][9][10][11][12][13][14] The large sample size of transplanted livers is one of the major interests of this study. Indeed, harvested livers offer an excellent opportunity to describe, in situ, the anatomic variants of the arteries since all e...

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

et al. 2007

View full text Add to dashboard Cite

show abstract

“…However, review of the literature suggests that not every branch of the hepatic artery requires reconstruction to provide sufficient arterial blood supply to the graft. This might be important for split-liver or living related liver transplantation, 24 because preoperative angiography and/or quantitative measurement of the blood flow by ultrasound provides support for this decision with objective data. Finally, an early diagnosis and repeat OLT can provide an excellent outcome to patients with HAT.…”

Section: Discussionmentioning

confidence: 99%

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Soliman

Bodingbauer

Langer

et al. 2003

Liver Transplantation

View full text Add to dashboard Cite

The goal of this study was to analyze the influence of multiple anastomosis on outcome in orthotopic liver transplantation (OLT) and its implications for split-liver and living related liver transplantation programs. In a retrospective study, 683 first OLTs in adults were analyzed. Complex hepatic artery reconstruction was defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries. OLT was performed in a standard manner. All patients had daily ultrasound examination. In this series we found 72 grafts (10.5%) with anatomic arterial variations that required complex hepatic artery reconstruction. There was no difference in primary organ function and demographic data compared with patients with simple arterial reconstruction. However, hepatic artery thrombosis (HAT) occurred in 9.7% of patients (7 of 72) with complex reconstruction in contrast to 2.0% in the control group (12 of 638; P < .001). Statistical analysis identified multiple anastomoses (P < .002) and primary nonfunction (P < .02) as significant risk factors for HAT. Three patients underwent successful thrombectomy for HAT, all others had to undergo retransplantation. Although in the group with complex arterial reconstruction increased graft loss caused by HAT was found early postoperatively, the overall 5-year patient and graft survival was not different for both groups. Although complex reconstruction is a risk factor for HAT, early diagnosis of HAT by daily ultrasound and early repeat OLT can provide similar 5-year survival as for patients with simple reconstruction. We conclude that complex hepatic artery reconstruction challenges conventional OLT as well as split-liver and living related liver transplantation, but does not necessarily affect its longterm outcome. O rthotopic liver transplantation (OLT) is one of the outstanding innovations in the treatment of end-stage liver diseases in recent decades. The enormous success of this new surgical procedure resulted in an increasing organ shortage, which is the main challenge for OLT nowadays. Great efforts have been made to enlarge the donor pool, and especially split-liver transplantation and living related liver transplantation were to contribute to the solution of this problem. However, because these new surgical techniques are determined by their technical feasibility and limits, concepts that have been considered controversial since the early period of OLT have become of particular interest. [1][2][3][4] In this context, the vascular reconstruction of the hepatic artery and factors related to hepatic artery thrombosis (HAT), one of the most life-threatening complication in liver transplantation, are still being discussed. Many reports on the incidence of anatomic variations of the hepatic artery have been published and risk factors for HAT have been identified, 5-8 but an actual systematic analysis assessing exclusively the role of graft revascularization on outcome is rare. Therefore, the goal of this study is to analyze the results of complex hepatic ...

show abstract

“…9,11 They also argue that single anastomosis leads to an increase in diameter and blood flow of the artery, and thus prove useful to prevent HA thrombosis. 12 In our 10 cases, ligation was performed after detection of pulsatile backflow.…”

Section: Discussionmentioning

confidence: 99%

Use of the Right Lobe Graft With Double Hepatic Arteries in Living-Donor Liver Transplant

Çakır¹,

Sabuncuoglu²,

Soyer³

et al. 2022

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant. Materials and Methods: Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 livingdonor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively. Results: A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anastomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%. Conclusions: According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.

show abstract

Should all hepatic arterial branches be reconstructed in living-related liver transplantation?

Cited by 89 publications

References 10 publications

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Use of the Right Lobe Graft With Double Hepatic Arteries in Living-Donor Liver Transplant

Contact Info

Product

Resources

About