Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation

Abstract

Hepatic artery thrombosis is the most common technical complication in liver transplantation. The objective of this study was to investigate the arterial complications of partial liver transplantation using microsurgical technique. At a period of 31-months, we participated in a total of 42 right lobes, 7 left lobes, and 1 whole-liver liver transplantations from cadaveric (n = 20) or living (n = 30) donors. Hepatic artery anastomosis was performed using microsurgical techniques. All anastomoses were accomplished successfully. Fifteen patients expired postoperatively and 35 hepatic artery anastomoses remained patent at a mean follow-up period of 10.6 +/- 8.4 months. The mean diameters of the donor and recipient hepatic arteries were 2.9 +/- 1.2 mm and 3.2 +/- 1.1 mm, respectively. Specific technical challenges were encountered during operation in eight cases (16%). We have found that microsurgical techniques are not only useful for a superior anastomosis but also reliable to adapt to vascular anomalies with less arterial complications. complications.

Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol

“…While it is thought that the major risk for HAT is a direct result of local trauma to the vessels during anastomosis, our results suggest that understanding the pro‐thrombotic state in the early days post‐LT and correcting it appropriately appears to be the intervention that has made the most significant difference in preventing HAT. Thus, both the use of microsurgical techniques and the appropriate management of coagulopathy are essential in minimizing risk of HAT …”

“…Pediatric LT remains a lifesaving and skill‐intensive procedure, where patients often experience high morbidity due to perioperative complications . Despite this, LT remains the gold standard for children with end‐stage liver failure.…”

Arterial Anastomosis in Living Donor Liver Transplantation

“…In most cases it is caused by a technical failure. The incidence of HAS after LTx is reported to be 3 -11%, although the introduction of microsurgery has significantly lowered the incidence of hepatic artery complications in the field of LDLT (Ulusal et al, 2006). More than 50% of HAS involve arterial anastomosis or graft artery (donor), while recipient artery stenosis is extremely rare.…”

Delayed primary closure and the incidence of surgical complications in pediatric liver transplant recipients

“…Development of surgical techniques, improved postoperative management and the introduction of refined immunosuppressive regimens have continued to improve the outlook for pediatric liver transplant (LT) recipients [1]. Pediatric transplant recipients often suffer high morbidity and remain more prone to postoperative complications [2].…”