Right hepatic arterial girdle around the common hepatic duct in liver donors: technical considerations for successful living donor liver transplantation

Cherukuru, Ramkiran; Rajalingam, Rajesh; Reddy, Mettu Srinivas; Rela, Mohamed

doi:10.1007/s00423-021-02213-w

Cited by 2 publications

(4 citation statements)

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“…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

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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.

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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

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“…Anatomic variations usually include the presence of 2 or 3 arterial grafts in the trunk. However, the presence of complex anomalies, such as the formation of a vascular girdle due to the passing of the right anterior HA and right posterior HA anteriorly and posteriorly to the common bile duct, respectively, has been described with different impacts on recipients’ outcomes and need for multiple arterial reconstructions during the recipient surgery 39 . It is also important to note and identify the origin of the segment 4 artery when using right lobe grafts so that this artery is adequately preserved in order not to compromise the arterial irrigation of the donors’ segment 4 on the remnant liver following a right hepatectomy.…”

Section: Technical Approach To the Living Donor Surgerymentioning

confidence: 99%

“…Adequate identification of right hepatic artery (RHA) trunks, branches, and trajectory reduces the risk of excessive dissection or denuding the bile duct during donor surgery while reducing the risk of a challenging arterial reconstruction in the recipient. [39] For right lobe grafts, the most commonly found anatomy is a single RHA from left to right and posterior to the common hepatic duct. Anatomic variations usually include the presence of 2 or 3 arterial grafts in the trunk.…”

Section: Graft Vascular Anatomymentioning

confidence: 99%

“…As a result, we are able to evaluate donor safety and anticipate additional measures needed for the recipient’s hepatic artery (HA) reconstruction, such as in the case of multiple donor HAs. Adequate identification of right hepatic artery (RHA) trunks, branches, and trajectory reduces the risk of excessive dissection or denuding the bile duct during donor surgery while reducing the risk of a challenging arterial reconstruction in the recipient 39 . For right lobe grafts, the most commonly found anatomy is a single RHA from left to right and posterior to the common hepatic duct.…”

Section: Technical Approach To the Living Donor Surgerymentioning

confidence: 99%

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