Hepatic Artery Reconstruction Research Articles

Smoothing the path: Reducing biliary complications, addressing small-for-size syndrome, and making other adaptations to decrease the risk for living donor liver transplant recipients

1. Over the course of the past 2 decades, living donor liver transplantation (LDLT) has become increasingly successful because many of the technical issues plaguing it have been resolved. 2. Although donor safety remains a concern, most challenges related to the recipient's surgery are now better understood, and they appear surmountable. 3. The following concepts need to be addressed for optimal recipient outcomes to be achieved: a. Reduction of the risk of small-for-size syndrome in LDLT (ie, the management of 4 factors: the recipient status, the portal pressure and inflow, the venous outflow, and the graft-to-recipient weight ratio/graft quality). b. Reduction of the risk of surgical complications (biliary complications, reconstitution of the middle hepatic vein outflow in the right lobe graft, and safe hepatic artery and portal vein reconstruction). c. Other adaptations for improving recipient outcomes (adaptations related to LDLT and adaptations common to deceased donor liver transplantation and LDLT).

Evaluation of multi-phase CT scanning for the liver transplantation

Objective To evaluation application of MSCTA technology in pre-and pro-liver transplantation.Methods Thirty - two patients with liver transplantation were performed with multi-phase CT scanning (MSCT).In hepatic artery and portal phase vascular 3D imaging reconstruction methods include multiple planar reconstruction ( MPR),maximum intensity projection ( MIP),volume rendering (VR).MIP images were measured with these parameters (CA,LGA,CHA,PHA,PV,SV,SMV in diameter).Results Hepatic arterial vascular imaging scan can show clearly within the scope of the abdominal aorta,gastroduodenal artery,hepatic artery,the left hepatic,celiac trunk,and its branches.Portal vascular imaging clearly showed that the portal vein system.MIP can use accurate measurement of vascular diameter abdominal aorta and portal,superior mesenteric vein,and splenic vein diameter.Control group with liver cirrhosis and liver cancer artery diameter had no significant difference in patients with portal hypertension and the portal vein [ ( 16.7 ± 2.4 ) mm ],mesenteric vein [ ( 10.8 ± 2.1 ) mm ],and splenic vein diameter [(13.1±1.9)mm] compared to the control group[(13.8 ±1.6)mm,(8.2 ±1.7)mm,(8.9±1.1)mm ],the difference was statistically significant ( P ＜ 0.05 ). Conclusions MSCTA can show the liver artery and portal vein system of the non-invasive method of checking,Joint MIP and VR application can provide more clinical liver transplant before the hepatic artery and portal vein of information,liver transplantation arteriovenous anastomoses provides for the monitoring of vascular diameter. Key words: Hepatic artery/radiography; Liver transplantation; Tomography,spiral computed; Angiography/methods

Retroperitoneal Dissection in Patients with Borderline Resectable Pancreatic Cancer: Operative Principles and Techniques

Pancreatectomy with aggressive vascular resection is increasingly being recognized as an appropriate treatment strategy for patients with borderline resectable PDAC after administration of chemotherapy and/or chemoradiation. Because tumor downstaging is an uncommon event, both venous and hepatic arterial resection and reconstruction might be necessary to achieve negative surgical margins and the favorable short-term and long-term outcomes we have reported previously. The technical approaches we have described here can be used as a basic foundation for operative safety and efficiency during these challenging operations.

Arterial complications after liver transplantation: the impact of allocation of arteries to the donor liver in multi-organ retrieval

Objective To study the impact of allocation of organ arteries and their reconstruction for donor livers on arterial complications after liver transplantation from organ clusters obtained by combined liver,kidney,pancreas and duodenum harvesting.The aim is to guide future use of donor organs more safely and rationally with a decrease in postoperative complications.Method We studied 11 patients.Results There was no hepatic artery anomaly.A Carrol artery patch was obtained at the bifurcation of the proper hepatic artery and the gastroduodenal artery in these donor livers.In one patient,an arterial graft was used because of inadequate arterial length,and arterial thrombosis developed which required re-transplantation.The hepatic arterial reconstruction was successful for the remaining 10 patients.One patient died of pulmonary infection 5 months post transplantation.Conclusion When combined liver,kidney,pancreas and duodenum harvesting was used,enough arterial length of the recipient must be preserved.There should be adequate and prompt communication between the teams carrying out the donor operation and the recipient operation.A Carrol arterial patch of the proper hepatic artery and the gastroduodenal artery for the donor liver,and the use of microsurgical vascular anastomosis in the operation are the keys to prevent hepatic arterial complications after liver transplantation.Multi-organ harvesting can be used for obtaining donor livers in liver transplantation. Key words: Liver transplantation; Multi-organ retrieval; Arterial thrombosis

Surgical rationalization of living donor liver transplantation by abolition of hepatic artery reconstruction under a fixed microscope

The small diameter of the hepatic artery is one of the complexities of living donor liver transplantation (LDLT). We analyzed whether the direct suture technique using surgical loupes can simplify the operative process for LDLT compared with fixed microscopic reconstruction. We applied the direct technique to rationalize the operative process and abolished routine microsurgery from 2004. Two hundred and nine LDLT with a postoperative period over 34 months were carried out from 1996 to 2008. The patients were divided into two groups: the micro group (children: 20, adults: 72) and the non-micro group (children: 12, adults: 97). Running anastomosis was undertaken in the non-micro group. The anastomotic size of the children was significantly smaller than that of the adults, but larger than 2 mm (2.38±0.4 vs. 2.7±0.47 mm, p=0.0005). By appropriate choice of the proximal artery, direct anastomosis is possible even in children. Early complications occurred in seven cases in the micro group, but none occurred in the non-micro group (p<0.05). Significant reductions were observed in operation time (p<0.0001), blood loss (p<0.05), and hospital stay (p<0.01) in the non-micro group. Non-microscopic anastomosis is useful for the rationalization of LDLT.

Impact of Hepatic Arterial Reconstruction on Orthotopic Liver Transplantation in the Rat

ABSTRACTOrthotopic liver transplantation (OLT) models in rats have been investigated in many studies, but detailed information on the impact of hepatic artery (HA) reconstruction on postoperative factors remains to be investigated. HA reconstruction also requires advanced skills. The effect of the reconstruction of the HA by a hand-suture technique in rats with a whole-liver syngeneic graft was investigated. Long-term survival, histopathological assessment, immunohistological evaluation, and blood biochemistry were investigated until postoperative day (POD) 28. From the early postoperative period, significant differences between OLTs with or without HA reconstruction were found in graft parenchymal damage, induction of apoptosis, and transaminase levels, though survival curves and the coagulation profile showed no differences. In OLT without HA reconstruction, biliary proliferation was decreased at POD 5–14, and total bilirubin level was increased at PODs 10 and 14. The study indicates that HA reconstruction is required for reliable OLT in rats.

Hepatic arterial reconstruction for orthotopic liver transplantation in the rat

BackgroundOrthotopic liver transplantation (OLT) models in rats have been investigated in many studies. The reconstruction of hepatic artery is required for reliable OLT and also requires advanced skills. MethodsThe hepatic artery reconstructions by a hand-suture technique and a new method using a micro T-tube were investigated in rats with a whole-liver syngeneic graft. Operative time and postoperative patency were compared between the hand-suture and micro T-tube techniques. ResultsOur technique using the micro T-tube shortened the operative time of recipient surgery compared with the hand-suture technique and prolonged the operative time for the donor. The patency ratio was maintained at 24h after OLT with hand suturing but was significantly reduced with the micro T-tube, which had a patency ratio of 0.83 only up to 6h after OLT. ConclusionThe micro T-tube technique may have potential usefulness in the rat OLT model but requires further modification.

Hepatic artery reconstruction following ablative surgery for hepatobiliary and pancreatic malignancies

ObjectiveHepatic artery (HA) reconstruction is an important part of resective surgery for advanced hepatobiliary and pancreatic malignancies, but few reports have been published. To identify indications for HA reconstruction, we retrospectively analyzed our surgical procedures and outcomes. MethodsEn-bloc resection of advanced hepatobiliary and pancreatic malignancies followed by HA reconstruction was performed in 35 patients. Patients ranged in age from 27 to 81 years and included 18 men and 17 women. The primary site of cancer included the bile duct in 22 patients, the pancreas in 7, and others in 6. Reconstruction of the HA was necessitated by HA resection due to direct cancer invasion in 29 patients and by accidental arterial injury during surgical procedure in 6 patients. ResultsThe HA was reconstructed with end-to-end anastomosis between hepatic arteries in 17 patients. Transposition of an intra-abdominal artery, such as the gastroepiploic artery, was required in 14 patients, and arterial grafting was required in 4 patients. Although the HA patency was achieved in 30 patients, 4 cases of arterial thrombosis and 1 case of arterial rupture developed postoperatively. The overall RFS time was analyzed in all patients, and mean and median RFS times were 18 and 9 months, respectively. ConclusionAlthough oncologic outcomes remain poor, HA resection and reconstruction can be performed in selected patients. We believe that the method of first choice for HA reconstruction is end-to-end anastomosis between HAs. A vascular autograft should be used only in selected cases.

Preexcisional artery reconstruction: A new strategy in multiple hepatic artery reconstruction for reducing ischemic injury of the liver

Multiple reconstructions of the hepatic arteries (HA) after cancer resection presents a surgical challenge, not only because it is technically demanding, but also because attention must be paid to potential ischemic injury to the liver caused by the prolonged ischemia. We present a novel "preexcisional artery reconstruction" method for minimizing ischemic injury of the liver. A 65-year-old woman presented with cholangiocarcinoma invading the HA. Pancreatoduodenectomy, resection, and multiple reconstruction of the HA were performed. First, the left hepatic artery (LHA) was reconstructed prior to the tumor resection. During this procedure, blood supply was maintained to most of the liver via the right hepatic artery (RHA). Then, resection of the tumor en bloc with the HA was performed, followed by reconstruction of the RHA. During this procedure, blood supply was maintained via the already-reconstructed LHA, thereby limiting the ischemic area. Use of this method allowed the ischemia time and region to be divided and minimized, thereby leading to a reduced risk of ischemia-related complications. We believe that this method may be one of the useful approaches in multiple HA reconstruction.

Hepatic Artery Reconstruction in Living Donor Liver Transplantation: Running Suture Under Surgical Loupes by Cardiovascular Surgeons in 180 Recipients

ObjectivesThe aim of our study was to retrospectively investigate the outcomes of hepatic artery (HA) reconstruction by cardiovascular surgeons in adult-to-adult living donor liver transplantation (A-A LDLT). MethodsFrom April 2007 to April 2011, 187 recipients underwent A-A LDLT. After excluding seven ABO-incompatible transplant recipients, we reviewed the courses of 180 patients including 125 men and 55 women of mean age 52.5 ± 9.2 years (range = 23–71). One hundred seventy-seven patients received right-lobe grafts with inclusion of middle hepatic vein (MHV); two, right-lobe grafts without MHV; and one, left-lobe graft. A continuous, single-stitch, running suture with the parachute technique was used for HA reconstruction. The anastomosis was performed by cardiovascular surgeons employing surgical loupes with 4.5× magnification. ResultsThe mean time for an arterial reconstruction was 10.7 ± 4.0 minutes (median = 10, range = 4–30). Hepatic arterial thrombosis (HAT) was encountered in 3 (1.66%) patients. One HAT that developed on postoperative day 1 was successfully rescued by the intra-arterial infusion of urokinase. Another patient required reoperation due to a redundant kinked HA. A third HAT patient underwent successful retransplantation with a cadaveric graft on postoperative day 6. In our series, no delayed HAT was detected and no recipient deaths were related to HAT. ConclusionHA reconstruction with a running suture under surgical loupes is a feasible technique in A-A LDLT. A speedy reconstruction can be performed by an experienced cardiovascular surgeon with a low incidence of HAT.

Hepatic arterial reconstruction with a short‐term patency by using micro T‐tube in rat liver transplantation

MicrosurgeryVolume 32, Issue 3 p. 253-254 Letter to the Editor Hepatic arterial reconstruction with a short-term patency by using micro T-tube in rat liver transplantation Tomohide Hori M.D., Ph.D., Corresponding Author Tomohide Hori M.D., Ph.D. hori.tomohide@mayo.edu Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital Kyoto, JapanDepartment of Neuroscience, Mayo Clinic in Florida, Birdsall Research Bldg., 3rd. Fl., Rm# 323, 4500 San Pablo Rd., Jacksonville, FL 32224Search for more papers by this authorShinji Uemoto M.D., Ph.D., Shinji Uemoto M.D., Ph.D. Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital Kyoto, JapanSearch for more papers by this authorFeng Chen Ph.D., Feng Chen Ph.D. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this authorAnn-Marie T. Baine B.S., Ann-Marie T. Baine B.S. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this authorLindsay B. Gardner B.S., Lindsay B. Gardner B.S. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this authorToshiyuki Hata M.D., Toshiyuki Hata M.D. Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital Kyoto, JapanSearch for more papers by this authorAimee R. Herdt Ph.D., Aimee R. Herdt Ph.D. Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FLSearch for more papers by this authorChristopher B. Eckman Ph.D., Christopher B. Eckman Ph.D. Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FLSearch for more papers by this authorJustin H. Nguyen M.D., Justin H. Nguyen M.D. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this author Tomohide Hori M.D., Ph.D., Corresponding Author Tomohide Hori M.D., Ph.D. hori.tomohide@mayo.edu Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital Kyoto, JapanDepartment of Neuroscience, Mayo Clinic in Florida, Birdsall Research Bldg., 3rd. Fl., Rm# 323, 4500 San Pablo Rd., Jacksonville, FL 32224Search for more papers by this authorShinji Uemoto M.D., Ph.D., Shinji Uemoto M.D., Ph.D. Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital Kyoto, JapanSearch for more papers by this authorFeng Chen Ph.D., Feng Chen Ph.D. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this authorAnn-Marie T. Baine B.S., Ann-Marie T. Baine B.S. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this authorLindsay B. Gardner B.S., Lindsay B. Gardner B.S. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this authorToshiyuki Hata M.D., Toshiyuki Hata M.D. Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital Kyoto, JapanSearch for more papers by this authorAimee R. Herdt Ph.D., Aimee R. Herdt Ph.D. Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FLSearch for more papers by this authorChristopher B. Eckman Ph.D., Christopher B. Eckman Ph.D. Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FLSearch for more papers by this authorJustin H. Nguyen M.D., Justin H. Nguyen M.D. Department of Transplant Surgery, Mayo Clinic Florida Jacksonville, FLSearch for more papers by this author First published: 08 March 2012 https://doi.org/10.1002/micr.21946Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue3March 2012Pages 253-254 RelatedInformation

Hepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy

BackgroundEn-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. MethodsThe authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed. ResultsIn both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months. ConclusionsThis new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement.

Hepatic artery reconstruction with gonodal vein interposition: First case in patients receiving liver from the living donor

SummaryBackground:Technical problems such as graft and vascular size are more common in living donor liver transplantation (LDLT) than in deceased donor liver transplantation. It is usually possible to get enough length of vessels on the graft, but the opposite situation is devastating. Finding the suitable vessel graft is life-saving in those situations. In this paper we present a case of gonodal vein interpositioning for hepatic artery reconstruction in an LDLT recipient. To the best of our knowledge, this is the first such case to be reported in the literature.Case Report:A 36-year-old man with cirrhosis secondary to hepatitis B underwent LDLT. Within minutes after completing the anastomosis, the artery was thrombosed. Disrupting the anastomosis showed subintimal dissection of the recipient right hepatic artery extending to the gastro-duodenal junction. A 4 cm segment of gonodal vein, which matched the diameter of the recipient hepatic artery, was used as a bridge. The patient’s postoperative recovery was excellent and Doppler ultrasonography demonstrated sufficient hepatic arterial blood flow. At long-term follow-up (18th months), the patient’s graft is still functioning.Conclusions:Gonodal vein interposition for hepatic artery reconstruction in living donor liver transplantation has not been previously reported. In light of the urgency of this situation, we believe it can be a life-saving reconstruction.

Management of vascular complications after living donor liver transplantation.

Vascular complications after liver transplantation remain a major source of morbidity and mortality for recipients especially those receiving LDLT owing to the complex vascular reconstruction. During the period from May 1999 to May 2004, 518 LDLT were performed in the Department of Liver Transplantation and Immunology, Kyoto University Hospital, Japan. The recipients were 261 males and 257 females. Pediatric cases were 230. The indications were cholestatic diseases in 42.5%, chronic hepatocellular diseases (CHD) in 13.3%, HCC in 18.5%, other tumors in 2.7% and others in 23%. Small for- size grafts in 4.8%, accepted size grafts in 16.0%, optimum size grafts in 74.5% and large-for-size grafts in 4.6%. Vascular complications occurred during hospital stay in 6.4%, within 3 months from discharge in 2.5% and after 3 months from discharge in 6.0%. The success rate of the management of HAT was 83.3%, portal vein complications was 97.6% and hepatic vein complications was 84.6%. Careful preoperative evaluation and the proper intraoperative techniques in vascular reconstruction prevent vascular complications. Intraoperative microsurgical technique for hepatic artery reconstruction decreases hepatic artery complications. Routine post transplant Doppler examination should be performed at least twice a day for the first week after the operation. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated by balloon angioplasty and endoluminal stent to avoid late complications and even mortality.

Adult right lobe live donor liver transplant with reconstruction of retro-portal accessory right hepatic artery

Adult right lobe live donor liver transplant with reconstruction of retro-portal accessory right hepatic artery

Total Pancreatectomy with En Bloc Celiac Axis Resection for a Pancreatic Adenocarcinoma Involving both the Gastroduodenal Artery and the Celiac Artery

A pancreatic adenocarcinoma involving both the celiac artery and the gastroduodenal artery is often considered to be unresectable because the simultaneous division of both arteries may result in an acute severe ischemia of the liver and the stomach. We report here a case of total pancreatectomy with en bloc celiac axis resection for a 61-year-old female with a pancreatic adenocarcinoma involving both the celiac artery and the gastroduodenal artery. The patient had a replaced right hepatic artery from the superior mesenteric artery and a replaced left hepatic artery from the left gastric artery, which was directly arising from the aorta. Preserving these collateral arteries, neither hepatic artery reconstruction nor total gastrectomy was needed after resection. The reported incidence of similar arterial anatomy was only 0.2% but the precise evaluation of arterial anatomy is important to offer a chance of curative resection for patients with usually unresectable locally advanced pancreatic cancer.

Expanding the applications of microvascular surgical techniques to digestive surgeries: a technical review

In living donor liver transplantation (LDLT), it is considered safer to reconstruct hepatic arteries (HAs) under a microscope than under conventional loupe magnification, because graft HA stumps are generally thin and short with an average diameter of approximately 2 mm. We first applied microvascular surgical techniques to HA reconstruction for LDLT in 1996. In most cases, we use a disposable double-clip to secure the graft and recipient arteries, and interrupted 8-0 nonabsorbable monofilament sutures. We next started performing resection and reconstruction of the right HA in a surgery for hilar cholangioma using the same technique as in LDLT. Lately, we have started applying microvascular surgical techniques to various digestive surgeries; namely, supercharge and superdrainage in esophageal surgery, vascular reconstruction in free jejunal interposition grafts for cervical esophageal cancer, resection and reconstruction of spontaneous HA aneurysms, jejunal artery reconstruction for spontaneous superior mesenteric artery dissections, and so forth. Mastering this technique is time consuming. However, once a surgeon masters the technique it has almost unlimited applications, and most vital vessels can be safely reconstructed using this method. We herein provide a technical review of the application of microvascular surgical techniques for various digestive surgeries.

Recipient Splenic Artery Utilization for Arterial Re-Anastomosis in Living Donor Liver Transplantation: Single-Center Experience

Thrombosis of recipient hepatic artery is a life threatening complication for liver transplantation. The etiology of hepatic arterial thrombosis is multi-factorial and can be caused by intimal dissection, poor surgical technique and coagulopathies. The patency of hepatic arterial flow is very important for both graft survival and patient survival. Intraoperative diagnosis of inadequate hepatic arterial flow found with Doppler ultrasonography is essential in order to achieve good results after liver transplantation. Urgent re-anastomosis is necessary when the arterial blood flow is insufficient. We performed 317 living donor liver transplantations from July 2004 to July 2011. We used recipient splenic artery for hepatic artery reconstruction in six patients. These six patients were included in this study. Using the recipient splenic artery is a simple, safe and practical alternative for hepatic artery re-anastomosis in living donor liver transplantations.

Calibrated extra-anatomic hepatic arterial reconstruction in living donor liver transplantation

Calibrated extra-anatomic hepatic arterial reconstruction in living donor liver transplantation

Hepatic Arterial Complications after Liver Transplantation: A Single-Center Experience

Background: We wanted to explore performing hepatic arterial reconstruction in living donor liver transplantation (LDLT) using right lobe liver grafts and cadaveric liver transplantation (CLT) in a single center. Methods: Thirty five LDLTs were performed from April 2005 to August 2009. The back wall support suture without twisting was used in most cases. A single RHA was anastomosed to the RHA in 24 patients, to the proper HA in 2 patients, to the RAHA in 4 patients, to the LHA in 2 patients and to an aberrant RHA arising from the SMA in 3 patients. The diameter of the donor RHA was between 1.5 mm and 3.0 mm (mean: 2.5 mm). In the 34 patients who underwent CLT, most of the arterial anastomoses were usually performed using two cuffs at the recipient HA and the GDA bifurcation and a branching point on the donor CHA with running and intermittent stay suture. Results: The total incidence of HA complication was 4.34% (3/69): 1 HAT (2.85%) occurred in a case of LDLT and 2 HAS (5.88%) occurred in a case of CLT. HAT occurred in 1 recipient on the 1st day following LDLT and 2 HAS occurred in CLT recipients at one and two months, respectively, following LDLT. Conclusions: HA complications occurred as a mild type of late complication and these complications might not be fatal in CLT. A low incidence of HAT can be achieved with using non-twisting method-guided microsurgical techniques for creating hepatic arterial anastomosis in LDLT. When early HAT occurs, early surgical reconstruction is mandatory for preventing the loss of the graft. Back wall sutures with only single needle suture might be a feasible method for HA microsurgical reconstruction.