Impact of Microsurgical Anastomosis of Hepatic Artery on Arterial Complications and Survival Outcomes After Liver Transplantation

Tan, Ek Khoon; Tan, Bien Keem; Fong, Hui Chai; Chua, Dennis; Chew, Khong Yik; Koh, Ye Xin; Chung, Alexander; Lee, Ser Yee; Teo, Jin Yao; Cheow, Peng Chung; Chan, Chung Yip; Goh, Brian K.P.; Jeyaraj, Prema Raj

doi:10.1016/j.transproceed.2020.08.017

Cited by 10 publications

(14 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…While several publications have compared outcomes for microscope versus surgical loupe use in LDLT, these data remain limited and often have confounding factors such as surgeon experience or disparate time frames. 26,28,29,33,35 According to a recent survey, $50% of surgeons (whether transplant or plastic and reconstructive) use an operating microscope for LDLT microanastomoses. 42 Not all centers performing LDLT have microsurgical capability and rates of microsurgical involvement vary by region.…”

Section: Discussionmentioning

confidence: 99%

“…1, a total of 320 unique abstracts were screened according to the study criteria, resulting in 20 studies for inclusion in the meta-analysis (►Table 1). 1,2,[4][5][6]16,20,[25][26][27][28][29][30][31][32][33][34][35][36][37]…”

Section: Systematic Reviewmentioning

confidence: 99%

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Microscope-Assisted Arterial Anastomosis in Adult Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Outcomes

Ebner

Bick

Emamaullee

et al. 2021

J Reconstr Microsurg

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Background Living donor liver transplantation (LDLT) has expanded the availability of liver transplant but has been associated with early technical complications including the devastating complication of hepatic artery thrombosis (HAT), which has been reported to occur in 14% to 25% of LDLT using standard anastomotic techniques. Microvascular hepatic artery reconstruction (MHAR) has been implemented in an attempt to decrease rates of HAT. The purpose of this study was to review the available literature in LDLT, specifically related to MHAR to determine its impact on rates of posttransplant complications including HAT. Methods A systematic review was conducted using PubMed/Medline and Web of Science. Case series and reviews describing reports of microscope-assisted hepatic artery anastomosis in adult patients were considered for meta-analysis of factors contributing to HAT. Results In all, 462 abstracts were screened, resulting in 20 studies that were included in the meta-analysis. This analysis included 2,457 patients from eight countries. The pooled rate of HAT was 2.20% with an overall effect size of 0.00906. Conclusion Systematic literature review suggests that MHAR during LDLT reduces vascular complications and improves outcomes posttransplant. Microvascular surgeons and transplant surgeons should collaborate when technical challenges such as small vessel size, short donor pedicle, or dissection of the recipient vessel wall are present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Microscope-Assisted Arterial Anastomosis in Adult Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Outcomes

Ebner

Bick

Emamaullee

et al. 2021

J Reconstr Microsurg

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“…5 In Singapore, at least 30% of liver transplant involves living donors due to a low donation rate. 6 Compared with deceased donor liver transplantation (DDLT), living donor liver transplantation (LDLT) is associated with higher incidences of hepatic artery thrombosis, thus increasing the risk of morbidity and mortality. The donor vessels in LDLT are usually smaller and shorter, thereby increasing technical difficulty.…”

mentioning

confidence: 99%

“…There was a lower incidence of shortand long-term arterial complications, especially in LDLT when the plastic surgery team performed arterial anastomosis under microscopy. 6 In this issue of the Annals, Tan et al reviewed 51 consecutive cases of liver transplantation (31 cases of DDLT and 20 cases of LDLT) at the Singapore General Hospital from January 2015 to December 2018. 8 The mean age was 58 and the most common indications for liver transplantation were non-alcoholic steatohepatitis, alcoholic liver disease and chronic hepatitis.…”

mentioning

confidence: 99%