Partial dearterialization of the liver allograft

Abstract

The clinical course of five patients with partial dearterialization of their hepatic allografts is described. One patient died and three others suffered serious morbidity as a direct or indirect result of this complication. Partial dearterialization of the liver allograft is a serious and potentially lifethreatening complication for which preservation of the complete hepatic arterial supply is important, even if this requires reconstruction of the aberrant vessels. KeywordsLiver transplantation; partial dearterialization; Arterial supply; in liver transplantationThe arterial blood supply of the liver is extremely variable, and the interruption of the hepatic artery is a feared complication in hepatobiliary or pancreatic surgical procedures, as well as in liver transplantation [2,7,10,11]. Although the clinical consequences of complete dearterialization of an allograft in orthotopic liver transplantation (OLTx) are well documented [10], little is known about the behavior of a partially dearterialized liver graft. We studied the clinical course of five patients who were known to have had this complication in order to clarify its significance. Patients and results Case 1A 20-year-old male underwent OLTx for sclerosing cholangitis. The graft had an aberrant left hepatic artery (HA) originating from the left gastric artery (LGA) and a proper HA that supplied the right hepatic lobe. Figure 1 demonstrates the postoperative course. On day 7 post-transplantation, he underwent Doppler ultrasonography of the graft, which failed to demonstrate arterial flow. Emergency hepatic arteriography revealed thrombosis of the proper HA, which was reconstituted through intrahepatic collaterals from the aberrant left HA (Fig. 2). A needle liver biopsy at that time revealed acute cellular rejection, for which OKT3 was administered for 2 weeks. The patient developed cytomegalovirus (CMV) hepatitis and subsequently required retransplantation. The failed allograft revealed no evidence of hepatic abscesses or lobar ischemia. The patient was discharged 3 months after the initial transplant and is doing well. A 62-year-old male with postnecrotic cirrhosis underwent OLTx. The aberrant left HA of the allograft originating from the LGA was erroneously injured during organ procurement and was ligated. His postoperative course was complicated by systemic bacterial and CMV infection. At 6 months post-transplantation, he developed a fever. Computed tomography revealed a 6.0 × 6.0 cm collection with an air-fluid level in the left lateral segment of the hepatic graft (Fig. 3), which was drained. The aspirate grew enterococcus and diphtheloids, for which appropriate antibiotics were given. The main HA was patent on Doppler ultrasonographs, and a percutaneous transhepatic cholangiogram was normal. The drainage catheter was removed 47 days later, when the cavity collapsed completely. He remains alive and well 13 months later. Case 3A 31-year-old male underwent uneventful OLTx for postnecrotic cirrhosis due to hepatitis B. The allograft had a smal...

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

“…[6][7][8] Indeed, in our policy such a parameter is not considered sufficient for decision making. In DDLT, a selective reconstruction policy for aHA has been much less explored, probably due to early negative experiences in the setting of unselected partial graft arterialization [24] or due to the inherent longer cold ischemia time and lower graft quality associated with DDLT, when compared with LDLT. In 2018, Montalti et al [2] reported on a single-center experience with a selective aLHA ligation.…”

?Arterialization?, ?revascularization?, ?rearterialization? ? what's in a name?

“…The inappropriate use of the terms "dearterialization" and "rearterialization" are also encountered in both transplantation and nontransplantation literature. "Dearterialization" has been used by some authors to describe an intraoperative situation where the hepatic arterial blood flow to a transplanted liver was found to be interrupted [22]. At the same time, other authors have referred to the purposeful interruption of the arterial blood supply to the liver harboring malignant primary or secondary tumor deposits as "dearterialization" [ l l , 141.…”