Surgical injuries of postmortem donor livers: Incidence and impact on outcome after adult liver transplantation

Abstract

The exact frequency and clinical consequences of surgical hepatic injuries during organ procurement are unknown. We analyzed the incidence, risk factors, and clinical outcome of surgical injuries in 241 adult liver grafts. Hepatic injuries were categorized as parenchymal, vascular, or biliary. Outcome variables were bleeding complications, hepatic artery thrombosis (HAT), and graft survival. In 82 livers (34%), 96 injuries were detected. Most injuries were minor, but clinically relevant injuries were detected in 6.6% (16/241) of the livers. Fifty (21%) liver grafts had some degree of parenchymal or capsular injury, 40 (17%) had vascular injury, and 6 (2%) had an injury to the bile duct. Procurement region was the only risk factor significantly associated with surgical injury. The rate of hepatic artery injury was significantly higher in livers with aberrant arterial anatomy. Bleeding complications were found in 18% of patients who received livers with a parenchymal or capsular injury in contrast to 9% without parenchymal injury (P ϭ 0.065). HAT was found in 23% of the patients who received a liver with arterial injury compared to 4% without arterial injury (P ϭ 0.001). Overall graft survival rates were not significantly different for grafts with or without anatomical injury. In conclusion, surgical injuries of donor livers are an underestimated problem in liver transplantation and can be observed in about one-third of all cases. Clinically relevant injuries are detected in 6.6% of all liver grafts. Arterial injuries are associated with an increased risk of HAT.

3D Anatomical Variations of Hepatic Vasculature and Bile Duct for Right Lateral Sector of Liver with Special Reference to Transplantation

“…The incidence of hepatic artery injury in procurement was significantly higher in grafts with aberrant arterial anomaly and arterial injury was associated with an increased risk of arterial thrombosis [36]. One of our cases had an aberrant RLA arising from the middle hepatic artery.…”

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“…6 Arterial injuries may be more frequent (12%) in grafts that have aberrant anatomy and may cause HAT after transplant. 1 The present cases suggest a possible strategy to address graft damage, especially presence of dHAT. If thrombosis is present in 1 aberrant vessel, the graft may be used after resection of the affected segments (cut-down liver graft).…”

“…Arterial injuries sustained during organ procurement occur in 1% to 12% transplants and contribute to the discarding of the graft. 1 These injuries are more common in the presence of abnormal anatomy and grafts from donation after circulatory death (DCD).…”

There is plenty for everyone: Transection of the infracardiac inferior vena cava during organ recovery

“…A recent study has shown that injury to the hepatic veins occurs in up to 3% of deceased donor liver recoveries. 9 When we are considering the anatomy of the suprahepatic vena cava, it is important to remember that the origin of the right hepatic vein is only 0.86 cm on average from the overlying diaphragm. 5 Just distal to the ostium of the right hepatic vein lies the confluence of the middle and left hepatic veins, which lie on the left anterolateral surface of the IVC.…”