The Reconstruction of Hepatic Arteries Using Extra-Anatomical Free Autografts in Living Donor Liver Transplantation

Abstract

Objectives: In living-donor liver transplantation (LDLT), microsurgical reconstruction of a hepatic artery is essential but requires challenging techniques, because graft arteries are short and usable vessel grafts are limited. Furthermore, hepatic artery thrombosis can be a lethal complication. Extra-anatomical jump graft reconstruction using free grafts is reported to have a high reocclusion rate. However, this technique is necessary when there is no other option. We report 4 cases of LDLT that required extra-anatomical reconstruction technique using free autografting from the aorta to the hepatic artery. In this technique, we used the systemic administration of gabexate mesilate that is the strong serine protease inhibitor. Methods:From 1991 to 2015, we performed 164 LDLTs. We retrospectively investigated 4 cases of extraanatomical reconstruction of the hepatic artery using free autografting from the aorta to the hepatic artery.Results: Two cases initially underwent anatomical reconstruction, but the arteries occluded early, because of the dissection of recipient's artery. There was no arterial graft, so we performed extra-anatomical reconstruction by using free autografting from the aorta to the hepatic artery. In the other two cases, the recipient arteries could not be used. Therefore, we initially performed extra-anatomical reconstruction by using radial artery free autografting as jump grafts from the aorta to the hepatic artery. In all cases, we used the systemic administration of gabexate mesilate, and could rescue all cases. Conclusion:We experienced and were able to salvage 4 cases that required free autografts. When there is no other means of reconstructing arteries, it is necessary to perform this procedure, depending on the condition of the intima of the recipient artery.

The extra‐anatomical jump graft reconstruction of the right hepatic artery after resection of a biliary tract malignancy with a common hepatic artery aneurysm: a case report

“…We were able to perform successful reconstruction of the RHA using a radial autograft as a jump graft. To the best of our knowledge, such reconstructions have only been reported in living donor liver transplantation (LDLT) cases .…”

“…Occlusion on the proximal side can be reconstructed by an arterial bypass, such as interposition bypass or extra‐anatomical jump graft bypass. We have previously performed extra‐anatomical jump graft reconstructions with a radial artery autograft as a jump graft from the abdominal aorta to the RHA during LDLT . The jump graft reconstruction needs two anastomoses, which increase the risk of HAT.…”

“…There was no other means of reconstructing the arteries, so we performed extra‐anatomical reconstruction using a left free radial artery autograft (length: 15 cm) as a jump graft from the aorta to the RHA (Fig. C,D) . Before grafting the radial artery, clinical assessment of the patient's nondominant (left) arm was performed using Allen's test.…”