What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Abstract

Background: The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up. Methods: From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope. Results: In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1-1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate redo anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis. Conclusions: Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to redo the HAR immediately.

Outcomes in Adult Liver Transplant Recipients Using Pediatric Deceased Donor Liver Grafts

“…The liver transplant technique used was surgeon preference/individual case dependent, following standardized techniques previously described. [10][11][12] Briefly, most implants were performed using a piggy-back technique, given this technique adapts better to the vena cava size discrepancies encountered when implanting pediatric grafts into adult recipients. A sideto-side cavo-cavostomy was the preferred caval reconstruction technique.…”

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

“…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]…”

“…13 HAT can be a particularly morbid condition, resulting in an unpredictable outcome ranging from ischemic cholangiopathy and recurrent hepatic abscesses to fulminant hepatic failure requiring emergent retransplantation. 14,20,21 Since the introduction of MHAR to LT, further evolution of techniques, increase in the number of trained microsurgeons, and greater volume of LDLT has resulted in a reduction of HAT rates to around 2.5%. 21 Despite advances in technique, HAT events often vary in incidence, and are reported in the literature at the rates of 1.9 to 16.6%.…”

How to reduce and manage the hepatic arterial complications in living and deceased donor liver transplantation?

“…HA reconstruction in DDLT is usually performed using surgical loops because the diameter of HA is large enough to perform anastomosis. However, Lin et al (6) has successfully performed HA reconstruction using microscope in DDLT. Personally I also prefer to microscopic arterial reconstruction in DDLT, particularly when obtaining the sizable recipient's HA with healthy wall is not easy under severe portal hypertension such as repeated history of upper abdominal operation including re-transplantation, salvage LT, and secondary biliary cirrhosis.…”