Anatomical Basis for Selective Multiple Arterial Reconstructions in Living Donor Liver Transplantation

Puri, Yogesh; Kumar, Pankaj; Rammohan, Ashwin; Narasimhan, Gomathy; Rajalingam, Rajesh; Cherukuru, Ramkiran; Rela, Mohamed

doi:10.1007/s00423-021-02176-y

Cited by 8 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, apart from one, none of the papers including ours showed an increased BC in LLG when only one artery was reconstructed. Moreover, even the paper which did show an increased rate of BC involved a very subjective decision-making process rather than an objective method as proposed by Sugawara et al and us [1,3]. As demonstrated in our data, we have had 85 LLG where 16 had dual arterial supply, of which only 4 (4.7%) had both arteries reconstructed.…”

Section: Dear Editormentioning

confidence: 59%

“…We thank Reddy et al for their insightful comments and for highlighting points which further bolster our objective decision-making criteria for selectively reconstructing multiple arteries in living donor liver transplantation (LDLT) [1]. As highlighted by Reddy et al, left lobe grafts (LLG) have a higher propensity to have multiple arteries due to a variable origin of the segment 4 artery.…”

Section: Dear Editormentioning

confidence: 99%

See 1 more Smart Citation

Objective method for selective reconstruction of multiple graft arteries to potentially reduce biliary complications

Puri

Rammohan

Marcos

et al. 2021

Langenbecks Arch Surg

Self Cite

View full text Add to dashboard Cite

Section: Dear Editormentioning

confidence: 59%

Section: Dear Editormentioning

confidence: 99%

Objective method for selective reconstruction of multiple graft arteries to potentially reduce biliary complications

Puri

Rammohan

Marcos

et al. 2021

Langenbecks Arch Surg

Self Cite

View full text Add to dashboard Cite

“…If there was no back bleed, then the second artery was also anastomosed separately in the recipient. When the graft arteries are equal in size or there was no back bleed during donor hepatectomy, back‐table reconstruction of graft arteries were performed using cryopreserved artery and single HA anastomosis was carried out in the recipient [18, 19].…”

Section: Methodsmentioning

confidence: 99%

Technique of Hepatic Artery Anastomosis in Living Donor Liver Transplantation: Review of Its Results in Over 1200 Adult and Pediatric Transplants

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Failure to achieve a good arterial inflow to the graft in living donor liver transplantation (LDLT) has disastrous consequences to the graft and patient survival. Standard microvascular techniques of hepatic artery (HA) anastomosis used in deceased donor liver transplantation are not applicable in LDLT. We present the results of our unique Backwall‐first technique of HA anastomosis in both adult and pediatric LDLT. Patients and methods Retrospective review of all consecutive patients who underwent LDLT from January 2010 to December 2020 was performed from our prospective database. Data with regard to early postoperative (90‐day) hepatic arterial complications were analyzed. Results A total of 1276 LDLTs (876 adults, 400 children) were performed during the study period. In the 90‐day postoperative period, HA anastomotic complications [thrombosis in 11 (0.9%); pseudoaneurysm in 3 (0.2%)] were observed in 14 recipients (1.1%) including 8 adults (0.9%) and 6 children (1.5%). Eight of these 14 recipients (0.6%) including 4 adults (0.5%) and 4 children (1%) had standard HA reconstruction. The remaining six (0.5%) including 4 adults and 2 children had complex arterial reconstruction with interposition graft and/or alternative arterial inflow. Conclusion The Backwall‐first technique of HA reconstruction described in this study achieved a very low HA complication rate in LDLT.

show abstract

“…Handling of multiple arteries in LDLT has been well reported, but there are no reports to suggest that ligation of the less significant artery increases the risk of SFSS. 108,109 Similarly, multiple ducts may increase the risk of biliary complications, which might complicate postoperative recovery and push a low-GRWR graft to SFSS, but per se multiple ducts does not influence the risk of SFSS. [110][111][112]…”

Section: Graft Anatomic Considerationsmentioning

confidence: 99%

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Hakeem,

Mathew,

Aunés

et al. 2023

Transplantation

Self Cite

View full text Add to dashboard Cite

Small-for-size syndrome (SFSS) is a well-recognized complication following liver transplantation (LT), with up to 20% developing this following living donor LT (LDLT). Preventing SFSS involves consideration of factors before the surgical procedure, including donor and recipient selection, and factors during the surgical procedure, including adequate outflow reconstruction, graft portal inflow modulation, and management of portosystemic shunts. International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplant Society of India Consensus Conference was convened in January 2023 to develop recommendations for the prediction and management of SFSS in LDLT. The format of the conference was based on the Grading of Recommendations, Assessment, Development, and Evaluation system. International experts in this field were allocated to 4 working groups (diagnosis, prevention, anesthesia, and critical care considerations, and management of established SFSS). The working groups prepared evidence-based recommendations to answer-specific questions considering the currently available literature. The working group members, independent panel, and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and evidence-based recommendations provided by working group 2 that can be implemented to prevent SFSS in LDLT patients.

show abstract

Anatomical Basis for Selective Multiple Arterial Reconstructions in Living Donor Liver Transplantation

Cited by 8 publications

References 23 publications

Objective method for selective reconstruction of multiple graft arteries to potentially reduce biliary complications

Objective method for selective reconstruction of multiple graft arteries to potentially reduce biliary complications

Technique of Hepatic Artery Anastomosis in Living Donor Liver Transplantation: Review of Its Results in Over 1200 Adult and Pediatric Transplants

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Contact Info

Product

Resources

About