HEPATIC ARTERY RECONSTRUCTION USING RECIPIENT’S RIGHT GASTROEPIPLOIC ARTERY IN LIVING RELATED LIVER TRANSPLANTATION

Abstract

P504 Aims: The aim of this study is to evaluate the outcome of hepatic artery reconstruction using the recipient’s right gastroepiploic artery (RGEA) in living-related liver transplantation (LDLT) when the recipient’s hepatic artery is not feasible for anatomosis. Methods: Ten arterial reconstructions using recipeint’s RGEA among 242 LRLT performed at our institution between January 1999 and December 2003 was retrospectively reviewed. Arterial reconstruction was carried out with the aid of an operating microscope using interrupted cunnel’s technique. The arterial blood flow of the graft was evaluated in the operation room after anastomosis and daily afterwards during the first postoperative week following transplantation. by means of doppler ultrasonography. Computed tomographic angiography was performed between 7th to 10th postoperative day to confirmed adequacy of the hepatic arterial blood flow. Results: The average age of the recipients was 47 years (Range 27-62) and average graft versus recipient weight ratio was 1.07. RGEA was initially used for anastomosis in 7 cases because recipient’s hepatic artery had severe endothelial damage or because of weak blood flow from hepatic artery thrombosis. In the remaining three, graft was revascularized using RGEA following a primary hepatic artery anastomosis. In the first of the three cases, hepatic artery anastomosis was initiallly performed after thrombectomy of the hepatic artery thrombosis but operative doppler ultrasonography showed minimal arterial flow, so reanastomosis was done using RGEA. In the second case, RGEA was used for anastomosis of the retransplanted liver after primary nonfuction of the initial graft on the 18th postoperative day. In case of third patient, RGEA was used because of severe hepatic artery stenosis on the 16th postoperative day following a conventional arterial reconstruction using the hepatic artery. Excellent hepatic arterial flow could be seen with doppler ultrasonography and computed tomographic angiography in all ten cases. There were no complications related with arterial anastomosis during short term term follow-up. Conclusions: Hepatic arterial reconstruction using recipient’s RGEA can be performed with ease and excellent hepatic flow can be accomplished. We therefore believe that when the standard technique using recipient’s hepatic artery is not feasible for anastomosis, recipient’s RGEA is a suitable alternative for hepatic artery reconstruction.