Use of the Recipient Celiac Trunk for Hepatic Artery Reconstruction in Orthotopic Liver Transplant

Abstract

Introduction: Arterial complications contribute to significant morbidity and mortality after liver transplant. If hepatic artery inflow to the graft is inadequate, alternative approaches can be considered, such as supraceliac or infrarenal aortic conduits and splenic artery for arterial inflow. Up to our knowledge we report the first series of cases using the recipient celiac trunk to provide arterial inflow to the donor liver allograft in orthotopic liver transplant (OLT). Methods: Between January-2005 and January-2012, we performed 928 OLTs, 850 cases are first transplant and 78 cases are retransplants, 143 cases are pediatric recipients and 785 cases are adult recipients. We used the recipient celiac trunk for arterial inflow in nine patients. Eight cases are first transplant and one case is a second transplant. Five cases are pediatric recipients and four cases are adult recipients. Male to female ratio is 3/6. Average follow up is 23 months. Retrospectively, we evaluated the indications, results and outcome of this technique. Doppler ultrasound of the liver (DUSL) was used to evaluate the arterial flow. Results: Indication are size mismatch between the donor and recipient common hepatic arteries (n= 5), and poor arterial inflow in the common hepatic artery (n=4). We used this technique in 1% of OLTs. We found that this technique was used more common in pediatric recipients with a p-value of 0.008 (3.4% of pediatric recipients and 0.5% of adult recipients). No hepatic artery thrombosis or arterial strictures were encountered. None of the patients developed ischemia of the stomach or duodenum, and none of them developed pancreatic or biliary complications related to poor arterial inflow. One patient had splenomegaly and splenic infarcts prior to transplant and this was not aggravated after the transplant. Another patient underwent spleenectomy at the time of the transplant due to associated autoimmune hemolytic anemia. DUSL on post-operative day 1 showed peak systolic flow ranging between (36-303 cm/sec) and resistive index ranging between (0.52-0.86). Arterial patency is 100 %. One, 3 & 5 year-patient and graft survival is 83%. One patient died 3 months after the transplant due to recurrent hepatoblastoma with a functioning graft and patent hepatic artery; all other patients are alive with a functioning graft and patent hepatic artery. Conclusion: The celiac trunk provides adequate arterial inflow in orthotopic liver transplant when the recipient's hepatic artery is not suitable to use, especially in pediatric patients. No complications were encountered as a result of sacrificing the branches of the celiac axis. We suggest that this technique might be considered as a viable option when an inadequate recipient hepatic artery is encountered.