The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Abstract

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 ...

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

“…In only two centers routine DUS was not performed (3,46 (12,27,28,33,42,44,48,51,52,54,62,65,71,84 (12,16,17,21,25,27,28,33,35,(41)(42)(43)(45)(46)(47)(48)(53)(54)(55)57,59,67,(70)(71)(72)(73)80,82,(84)(85)(86)(87) (12,27,28,33,42,…”

“…7 Only manuscripts mentioning the outcome are included. I 2,12,16,17,21,27,28,30,35,41,42,45,46,48,[51][52][53][54][55][56][57][58][59]61,62,64,65,[67][68][69][70][71][72][73]77,80,82,[84][85][86][87]16,17,21,25,27,28,33,35,[41][42][43]…”

Acute paranoid psychosis as sole clinical presentation of hepatic artery thrombosis after living donor liver transplantation

“…At transplantation the patient required a complex arterial reconstruction with an interposition graft which is a known risk factor for HAT [2,8]. Whether supraceliac or infrarenal placement of the interposition graft is beneficial remains equivocal [1,9].…”

Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation

“…While vessel diameter should be maximized, excessively small hepatic arteries (diameter, <1 mm) can usually be ligated if there is sufficient back flow in arterial vessels at the time when the hepatic artery is flushed on the back table. 42 Quinones-Baldrich et al 43 first described the gastroduodenal branch-patch technique using the bifurcation between the gastroduodenal and the proper hepatic artery in both the donor and the recipient. This technique is associated with a significant reduction in thrombosis and stenosis compared with the classical end-to-end anastomosis.…”