Arterial Reconstruction in Living Donor Liver Transplantation: Technical Difficulties and Related Complications in 210 Cases.

Abstract

Introduction: Hepatic artery (HA) reconstruction is still one of the most difficult procedures in living donor liver transplantation (LDLT). HA Complications range between 4 to 25% and often lead to graft loss and patient death. Objectives: To study technical difficulties in HA reconstruction and determine risk factors of HA complications and management to improve the outcome. Patients and Methods: Two hundred and ten cases of LDLT were done at National Liver Institute, Menoufiya University, Egypt, during the period from April 2003 till December 2013. The records of these patients were reviewed as regard preoperative characteristics of the donor and the recipient, intraoperative data including characteristics of both donor and recipient arteries, different techniques, technical difficulties and their management, and finally postoperative arterial complications. These data were collected and statistically analyzed. Results: This study included 174 (82.8%) adults and 36 (17.2%) pediatrics. The numbers of graft arteries were; single artery in 186 cases (88.5%), two arteries in 21 cases (10%) and 3 arteries in 3 cases (1.4%). Single arterial reconstruction was done in 197 cases (93.8%) and more than one anastomosis in 13 cases (6.2%). The technical difficulties recorded were in the form of size discrepancy in 72 cases (34.2%), short recipient artery stump in 13 cases (6.1%) and intimal dissection in the recipient arteries in 7 cases (3.3%). Postoperative arterial complications were recorded in 30 cases (14.2%), 26 of them were adults and the remaining 4 cases were pediatrics. These complications were in the form of thrombosis in 8, stenosis in 16, and steal in 4 and pseudo-aneurysm in 2 cases. Conclusion: Technical difficulties during arterial reconstruction could be managed safely. Number of graft arteries, size and quality of both graft and recipient arteries are possible risk factors for postoperative arterial complications. Proper selection of grafts and delicate manipulations during recipient hepatectomy could avoid such complications.