Impact of Hepatic Artery Variations and Reconstructions on the Outcome of Orthotopic Liver Transplantation

Abstract

Background Donor variational arteries often require complex reconstruction. Methods We analysed the incidence of different variations, types of arterial reconstructions and their impact on postoperative results from 409 patients undergoing liver transplantation at Karolinska Institute between 2007 and 2015. Results A total of 292 (71.4%) liver grafts had a standard hepatic artery (SHA), and 117 (28.6%) showed hepatic artery variants (HAV). 58% of HAV needed reconstruction. The main variations were variant left hepatic artery (45.3%) from the gastric artery; variant right hepatic artery (38.5%); and a triple combination of variant right and left hepatic artery and the proper hepatic artery from the common hepatic artery (12.8%); other 3.4%. Patients/graft survival and arterial complications were not different between SHA and HAV. Incidence of biliary stricture was numerically higher in left hepatic artery variants (p = 0.058) and in variants where no arterial reconstruction was performed (p = 0.001). Operation and arterial warm ischaemia time were longer in the HAV group. The need for intraoperative re-reconstruction was higher in the HAV group (p = 0.04). Intraoperative bleeding was larger after back-table reconstruction than with intraoperative reconstruction (p = 0.04). Conclusion No overall differences were found between the HAV and the SHA groups. Occurrence of a variant left hepatic artery and HAV with no reconstruction seems to increase the risk of biliary strictures.

CT Angiographic Study on the Variations of the Hepatic Arteries in the Living Liver Donors of the South Indian Population.

“…12 with the results of the present study where the variations of the left hepatic artery were more than the right hepatic artery. 23 In the present study the incidence of replaced RHA (Type 3) was observed in 9.5% and the accessory RHA was observed in 4% cases. The type 3 that is an accessory/replaced RHA is of most important type as it always requires an arterial reconstruction.…”

Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach

“…Cold and warm ischemia time were defined as the time interval between cross‐clamp and graft placement into the recipient abdomen, and between graft placement into the recipient abdomen and portal declamping, respectively. In accordance with previous reports, [ 1,2 ] the arterial ischemia time was defined as the time interval between portal declamping and completion of arterial reconstruction.…”

Reconstruções Arteriais No Backtable Do Transplante De Fígado: Onde Estamos?

“…Pacientes com TAH têm taxas de mortalidade entre 27-58%, e quando o retransplante não é realizado, essa taxa cresce para cerca de 73%. 15,16 De acordo com o período em que a TAH ocorre após o transplante, ela pode ser classificada precoce ou tardia, sendo estabelecido como parâmetro o intervalo de um mês antes ou depois da cirurgia, respectivamente. No entanto, esse período que divide a TAH precoce da tardia ainda varia na literatura.…”

“…6,8,17 Condições como aterosclerose e alterações na túnica íntima mantêm relação com a idade do paciente e com comorbidades como a hipertensão ou diabetes mellitus e, por isso, é de extrema importância o conhecimento desses fatores para uma efetiva execução da reconstrução arterial. 8,14,16,17 que a sutura foi colocada corretamente através de todas as camadas arteriais, e que não há envolvimento da parede posterior durante a sutura da parede anterior. Além disso, é preciso também minimizar a incidência da dissecção da túnica íntima, realizando cuidadosa dissecção e preparação da artéria receptora, afim de evitar problemas importantes como a embolização.…”