The impact of extra-anatomical hepatic artery reconstruction during living donor liver transplantation on biliary complication, graft and patient survival.

Abstract

Introduction: This study is designed to analyze the feasibility of extra-anatomical hepatic artery reconstruction in living donor liver transplantation. Method: Patients who underwent their first living donor liver transplantation in our center from January 2008 to December 2017 were reviewed. Hepatic artery reconstruction was classified as anatomical or extra-anatomical reconstruction. Comparisons of the background characteristics and post-transplantation outcome including complications, biliary complications, graft survival and overall survival were performed. Potential risk factors for bile leakage was analyzed using multivariable logistic regression analysis. Potential risk factor for biliary stricture-free survival, graft survival, and overall survival were analyzed using multivariable Cox proportional hazard models. Result: Among 800 patients, 35 (4.4%) underwent extra-anatomical reconstruction. Extra-anatomical reconstruction (n=2/35, 5.7%) showed similar rate of hepatic artery complication to anatomical reconstruction. (n=46/772, 5.9%, P=0.699) Seven patients (7/35, 20.0%) with extra-anatomical reconstruction experienced hepatic artery complication after anatomical reconstruction and changed to extra-anatomical reconstruction. Extra-anatomical reconstruction showed significant risk of increased bile leakage (OR=4.167, CI 1.928-9.006, P<0.001) along with multiple bile duct (OR=1.606, CI=1.022-2.526, P=0.040) and hepaticojejunostomy (OR=4.108, CI=2.190-7.707, P<0.001). However, extra-anatomical reconstruction showed no statistical relationship to poor biliary stricture-free survival (HR=1.602, CI=0.982-2.613, P=0.059), graft survival (HR=1.745, CI=0.741-4.109, P=0.203) and overall survival. (HR=1.405, CI=0.786-2.513, P=0.251) Hepatic artery complication was related to poor biliary stricture-free survival (HR=2.060, CI=1.329-3.193, P=0.001), graft survival (HR=5.549, CI=2.883-10.681, P<0.001) and overall survival. (HR=1.958, CI=1.195-3.206, P=0.008) Conclusion: Extra-anatomical hepatic artery reconstruction during living donor liver transplantation was not a risk factor of biliary stricture, graft failure and overall survival.