Anatomic Variation of the Right Hepatic Artery and its Reconstruction for lIving Donor Liver Transplantation Using Right Lobe Graft

Ahn, Curie; Lee, S.-G.; Hwang, Shin; Moon, Deok‐Bog; Ha, Tae‐Yong; Lee, Y.-J.; Park, K.-M.; Kim, K.-H.; Kim, Y.-D.

doi:10.1016/j.transproceed.2005.01.068

Cited by 40 publications

(43 citation statements)

References 9 publications

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“…In fact, the necessity for vascular reconstruction has led some authors to exclude donors with < 3mm arteries 2 . The right lobe grafts have been the main type of partial liver grafts for adult-to-adult living donor liver transplantation and the anatomy of the right liver must be intensively investigate to assure safety to the donor and prevention of recipient complications 3 . However, there are only few articles dealing specifically with the right hepatic artery anatomy.…”

Section: Introductionmentioning

confidence: 99%

Arterial diameter of the celiac trunk and its branches: anatomical study

Silveira

Silveira²,

Fazan³

2009

Acta Cir. Bras.

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Purpose: Despite the fact that anatomical variations of the celiac trunk are well explored in the literature, information on these vessels diameters is scanty. The aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases presenting anatomical variations of these vessels. Methods: Twenty-one formalin fixed adult male cadavers were appropriately dissected for the celiac trunk identification and arterial diameter measurements. Arteries measured included the celiac trunk and its main branches (splenic artery, left gastric artery and common hepatic artery), as the proper hepatic artery, right gastric artery, the left and right hepatic arteries and the gastroduodenal artery. Results: From the 21 cadavers, 6 presented anatomical variations of, at least, one of the above mentioned branches. The average arterial diameter comparisons between groups (normal and variable) clearly showed smaller diameters for variable vessels, but with no significant difference. Conclusion: Our data indicates the possibility of a diameter reduction of the celiac trunk main branches in the presence of anatomical variations. This should be taken into account on the selection for the liver transplantation donors.

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Section: Introductionmentioning

confidence: 99%

Arterial diameter of the celiac trunk and its branches: anatomical study

Silveira

Silveira²,

Fazan³

2009

Acta Cir. Bras.

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“…According to our experience, the RGEA matches the very small artery of an RPS graft. 14,15 The diameter of the bile duct opening for the RPS grafts was also smaller than that for the RL grafts. The small bile duct of a partial graft is regarded as a risk factor for postoperative biliary complications.…”

Section: Discussionmentioning

confidence: 89%

Volumetry-based selection of right posterior sector grafts for adult living donor liver transplantation

Kim

Wang

et al. 2011

Liver Transpl

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To determine the feasibility of volumetric criteria without anatomic exclusion for the selection of right posterior sector (RPS) grafts for adult-to-adult living donor liver transplantation (LDLT), we reviewed and compared our transplant data for RPS grafts and right lobe (RL) grafts. Between January 2008 and September 2010, adult-to-adult LDLT was performed 65 times at our institute; 13 of the procedures (20%) were performed with RPS grafts [the posterior sector (PS) group], and 39 (60%) were performed with RL grafts (the RL group). The volumetry of the 13 RPS donor livers showed that the RPS volume was 39.8% 6 7.6% of the total liver volume. Ten of the 13 donors had to donate RPS grafts because the left liver volume was inadequate. All donor procedures were performed successfully, and all donors recovered from hepatectomy. However, longer operative times were required for the procurement of RPS grafts versus RL grafts (418 6 40 versus 345 6 48 minutes, P < 0.001). The postoperative recovery of liver function was smoother for the donors of the PS group versus the donors of the RL group. The RPS grafts had significantly smaller hepatic artery and bile duct openings than the RL grafts. All recipients with RPS grafts survived LDLT. No recipients experienced vascular graft complications or small-for-size graft dysfunction. There were no significant differences in the incidence of posttransplant complications between the donors and recipients of the PS and RL groups. The 3-year graft survival rates were favorable in both groups (100% in the PS group versus 91% in the RL group). In conclusion, the selection of RPS grafts by volume criteria is a feasible strategy for an adult-to-adult LDLT program. Liver Transpl 17:1046-1058, 2011. V C 2011 AASLD.Received January 26, 2011; accepted May 7, 2011.Living donor liver transplantation (LDLT) is widely performed for end-stage liver disease, especially in countries in which deceased donors are scarce. [1][2][3] However, an LDLT program is more complicated than a deceased donor liver transplantation program because of the living sources of the grafts. Adult-toadult LDLT can be performed successfully when appropriate preoperative evaluations, surgical procedures, and postoperative management techniques are used for the donor and the recipient. It is well known that adequate donor liver volumetry is one of the key factors for both the safety of living donors and the survival of recipients of adult-to-adult LDLT. 4,5 In addition to an adequate liver volume, the selection of the appropriate liver graft from the donor might be critical for successful adult-to-adult LDLT.In adult-to-adult LDLT, the size of the left lobe (LL) graft is frequently insufficient to meet the metabolic demands of the recipient, whereas the size of the right lobe (RL) graft usually satisfies the liver volume requirements of the recipient. However, RL donation carries a higher risk to the donor than LL donation.Abbreviations: ALT, alanine aminotransferase; CHD, common hepatic duct; CT, computed tomography; DD...

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“…[4][5][6][7] As far as the left liver graft is concerned, this rate is higher than 50%, as the middle hepatic artery usually originates from the right HA. 8,9 The most common surgical techniques for a double HA anastomosis are direct insitu anastomosis and exsitu anastomosis. 8,10 In a direct insitu anastomosis, the recipient's right or left hepatic HA is anastomosed to the dominant graft artery, which is larger in diameter.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The most common surgical techniques for a double HA anastomosis are direct insitu anastomosis and exsitu anastomosis. 8,10 In a direct insitu anastomosis, the recipient's right or left hepatic HA is anastomosed to the dominant graft artery, which is larger in diameter. The graft arterial supply is checked on the other artery of the graft by pulsatile backflow test and Doppler US, and, if appropriate, the other arterial anastomosis is performed.…”

Section: Discussionmentioning

confidence: 99%

“…While some advocate a double anastomosis to allow safe arterial perfusion for the graft that would otherwise not receive an arterial supply, 7,8 others defend that ligation of either HA should achieve rearterialization of the interlobar collateral arteries, which might compensate the arterial supply for the graft. 9,11 They also argue that single anastomosis leads to an increase in diameter and blood flow of the artery, and thus prove useful to prevent HA thrombosis.…”

Section: Discussionmentioning

confidence: 99%

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Use of the Right Lobe Graft With Double Hepatic Arteries in Living-Donor Liver Transplant

Çakır¹,

Sabuncuoglu²,

Soyer³

et al. 2022

Exp Clin Transplant

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Objectives: We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant. Materials and Methods: Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 livingdonor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively. Results: A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anastomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%. Conclusions: According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.

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Anatomic Variation of the Right Hepatic Artery and its Reconstruction for lIving Donor Liver Transplantation Using Right Lobe Graft

Cited by 40 publications

References 9 publications

Arterial diameter of the celiac trunk and its branches: anatomical study

Arterial diameter of the celiac trunk and its branches: anatomical study

Volumetry-based selection of right posterior sector grafts for adult living donor liver transplantation

Use of the Right Lobe Graft With Double Hepatic Arteries in Living-Donor Liver Transplant

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