Hepatic Artery Reconstruction in Living Donor Liver Transplantation With the Radial Artery Interpositional Graft

Fong, Hui Chai; Tan, Eng Lee; Chew, Khong-Yik; Raj, Prema; Tan, Bien‐Keem

doi:10.1016/j.transproceed.2021.01.007

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…To further address the increased friability of vessels with prior TACE, Fong et al has implemented a far-and-near suturing technique, creating a staggered rather than linear suture line to minimize fissuring. 19 The use of loupes versus operative microscopes during LDLT is a widely debated topic with no consensus to date. The advantages of the operating microscope include the higher magnification which offers better visualization of the complex vasculature, including the intimal and medial vessel layers.…”

Section: Discussionmentioning

confidence: 99%

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Arterial Anastomosis Using Microsurgical Techniques in Adult Live Donor Liver Transplant: A Focus on Technique and Outcomes at a Single Institution

Huang

Fahradyan

Ahearn

et al. 2022

J Reconstr Microsurg

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Background Microvascular hepatic artery reconstruction (MHAR) is associated with decreased rates of hepatic artery thrombosis (HAT) in living donor liver transplantation (LDLT). There is a paucity of literature describing the learning points and invitation of this technique at the institutional level. The objective of this study is to report our institutional experience using MHAR in adult LDLT with a focus on technique and outcomes. Methods A retrospective review of adult patients who underwent LDLT from January 2012 to December 2020 was conducted. Patients were divided into two groups, those who underwent LDLT without MHAR and with MHAR. We analyzed cases for technical data including donor and recipient artery characteristics, anastomotic techniques, intraop events, and postop complications. A Mann–Whitney test was performed to compare outcomes between non-MHAR and MHAR patients. Results Fifty non-MHAR and 50 MHAR patients met inclusion criteria. Median age at transplantation was 58 (interquartile range [IQR] 11.8) and 57.5 years (IQR 14.5), respectively. Median follow-up for MHAR patients was 12.8 months (IQR 11.6). The most common recipient arteries were the right hepatic artery (HA) (58%) and left HA (20%). Median size of recipient and donor arteries were 3.3 mm (IQR 0.7) and 3.1 mm (IQR 0.7), resulting in a median mismatch size of 0.3 mm (IQR 0.4). Median microanastomosis time was 44 minutes (IQR 0). HAT, graft failure, and mortality rates were higher in the non-MHAR cohort (6% vs. 0%, 8% vs. 0%, and 16% vs. 6%, respectively); however, these did not reach statistical significance. Conclusion This study found lower rates of HAT and graft failure after implementing MHAR, though statistical significance was not achieved. Larger cohort studies are needed to further assess the potential benefit of MHAR in adult LDLT. From our experience, MHAR requires cooperation between the transplant and microsurgical teams, with technical challenges overcome with appropriate instrumentation and planning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arterial Anastomosis Using Microsurgical Techniques in Adult Live Donor Liver Transplant: A Focus on Technique and Outcomes at a Single Institution

Huang

Fahradyan

Ahearn

et al. 2022

J Reconstr Microsurg

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“…In such cases, two strategies can be adopted: (I) interposition grafts; (II) extra-anatomical recipient artery. For interposition grafts, various donor vessels have been used, such as the radial artery, iliac artery, inferior mesenteric artery, superior rectal artery, and great saphenous vein ( 28 - 31 ). Some of the extra-anatomical arteries used include left gastric artery, right gastroepiploic artery, right gastric artery, gastroduodenal artery, splenic artery and cystic artery ( 30 , 32 ).…”

Section: Preparation For Microsurgery In Liver Transplantmentioning

confidence: 99%

The role of reconstructive microsurgeons in liver transplantation—a narrative review

Chang,

Cheah

2024

Ann Transl Med

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Background and Objective Liver transplantation is a life-saving procedure, but also associated with complications. Hepatic artery thrombosis is one of the most devastating complications, especially for living donor liver transplantation. The application of microsurgical techniques for hepatic artery reconstruction has greatly reduced the risk of hepatic artery thrombosis. In this narrative review, we discuss the technical considerations and challenges faced in microsurgical reconstruction of hepatic artery in liver transplantation. Methods PubMed, Web of Science, and Google Scholar were searched for keywords relating to “liver transplantation”, “microsurgery”, “living donor liver transplantation”, “deceased donor liver transplantation”, “hepatic artery”, “hepatic artery thrombosis”, “hepatic artery reconstruction” and “microsurgical anastomosis”. Relevant articles pertaining to the technical considerations and challenges of microsurgery in liver transplantation were included. Key Content and Findings The conditions of liver transplantation pose unique challenges to the microsurgeon. Nonetheless, there are described strategies that can overcome these conditions, as well as technical details that may improve the outcomes of hepatic artery reconstruction. These strategies start from proper positioning of the patient, conscientious selection of donor and recipient hepatic vessels, and minimizing movements during critical microsurgical anastomosis. Technical details include techniques to overcome vessel delamination, size mismatch, poor quality vessels, and short vessel stump. This review also explores the outcomes of microsurgical hepatic arterial reconstruction. Conclusions There are various strategies to mitigate the challenges of microsurgery in liver transplant. Microsurgery improves the outcome of liver transplantation. Microsurgeons will continue to be a priceless resource that all liver transplant teams should have.

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Use of the Descending Branch of the Lateral Circumflex Femoral Artery as an Arterial Graft in Living Donor Liver Transplant

Hong

Fong

Chew

et al. 2021

Transplantation Proceedings

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Hepatic Artery Reconstruction in Living Donor Liver Transplantation With the Radial Artery Interpositional Graft

Cited by 4 publications

References 16 publications

Arterial Anastomosis Using Microsurgical Techniques in Adult Live Donor Liver Transplant: A Focus on Technique and Outcomes at a Single Institution

Arterial Anastomosis Using Microsurgical Techniques in Adult Live Donor Liver Transplant: A Focus on Technique and Outcomes at a Single Institution

The role of reconstructive microsurgeons in liver transplantation—a narrative review

Use of the Descending Branch of the Lateral Circumflex Femoral Artery as an Arterial Graft in Living Donor Liver Transplant

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