Technique of Dual Hepatic Reconstruction in Living Donor Liver Transplantation

Abstract

Introduction: Hepatic artery reconstruction is technically the most important anastamosis during implantation as thrombosis of the artery can lead to loss of the graft. Dual hepatic arteries to either half of the lobe in a donor has been a contraindication as reconstruction of these small vessels in the recipient is technically demanding and has high rates of complications. Aim: We demonstrate a novel backbench reconstructive technique to manage dual hepatic arteries in the donor graft. Method: The Donors are assessed with a triphasic CT scan to ascertain the arterial anatomy. In the case of 2 hepatic arteries care is taken in the donor hepatectomy and the arteries are isolated and preserved. A high Hilar dissection approach is used in the recipient hepatectomy. The right and left hepatic arteries are traced back to their common trunk. The common trunk is divided along with its bifurcation in the recipient. The right and left hepatic arteries are anastamosed to the 2 arteries of the graft in the back bench with 8-0 Prolene interrupted. After reperfusion of the graft the arterial conduit is anastamosed to the common hepatic artery of the recipient using the same technique. All anastamosis performed under 4.5 loupe magnification. An on table Doppler is performed to ascertain the flow and RI in both the arteries. Doppler studies are done routinely for 5 post operative days. Results: In the last 100 consecutive Liver transplants, we had used this technique twice with no incidence of Hepatic artery thrombosis. All patients receive low molecular weight heparin once the INR falls below 1.5 and at discharge Aspirin 75mgs is added and is continued for 6 months. Conclusion: The use of the recipient's native common hepatic artery with its bifurcation for the reconstruction of 2 donor arteries is a valuable surgical option in Living donor Liver transplantation.