Hepatic arterial reconstruction and complications management in adult-to-adult living donor liver transplantation

Abstract

To explore the experience of hepatic arterial reconstruction and its management of complications in adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe liver grafts. From January 2002 to July 2006, 50 of A-A LDLT using right lobe liver grafts were performed. All arterial anastomosis were performed to protect the donor hepatic arterial supply, in which donor right hepatic artery was sutured to recipient right hepatic artery in 24 patients, to recipient proper hepatic artery in 12 patients, to recipient left hepatic artery in 3 patients, to recipient common hepatic artery in 2 patients, to recipient aberrant right hepatic artery arising from superior mesenteric artery in 2 patients. Interpositional bypass using autogenous saphenous vein was performed between donor right hepatic artery and recipient common hepatic artery in 2 patients. Bypass was done between donor right hepatic artery and recipient abdominal aorta using autogenous saphenous vein in 2 patients and using stored cadaveric iliac vessels in 2 patients respectively. The diameter of donor right hepatic artery is between 1.5-2.5 mm, microsurgical technique was used under the magnified lobe of 3.5 times and operative microscope of 5-10 times. In these series, hepatic artery thrombosis (HAT) occurred in 2 recipients on 1st and 7th days following A-A LDLT (4%), which were revascularized with autogenous saphenous vein between donor right hepatic artery and recipient abdominal aorta immediately, HAT in 1 recipient occurred one and a half month following A-A LDLT, but no symptom was presented. No hepatic artery stenosis and aneurysm occurred during follow-up period. No death related to hepatic artery complications occurred. All recipients were followed up from 2 to 52 months (mean follow-up 9 months). 1-year survival rate was 92%. Proper anastomotic vessel choose and use of microsurgical technique in hepatic arterial reconstruction would reduce significantly the incidence of hepatic artery complications and provide an excellent graft survival following A-A LDLT.