In pediatric end-stage liver disease patients, the use of partial liver grafts from adult living donors has been increasing for liver transplantation due to a shortage of size-matched liver allografts. Partial liver grafts commonly involve multiple hepatic artery (HA) stumps. In these cases, a smaller HA may elicit hepatic artery thrombosis (HAT). Whether to reconstruct all HA stumps on a graft is an ongoing debate. This study was designed to validate the safety of partial reconstruction of multiple HAs in pediatric living donor liver transplantation (LDLT) cases. From January 2000 to June 2014, 159 pediatric patients underwent LDLT. Among these, ABOi cases, re-transplantation cases, and right lobe cases were excluded. The remaining 136 patients were categorized into three groups: single HA group (group 1, n = 74), multiple HAs with total anastomosis group (group 2, n = 23), and multiple HAs with partial reconstruction group (group 3, n = 39). Biliary complication rate, HA complication rate, patient survival, and graft survival were compared between groups. Partial reconstruction was performed only when there was pulsatile back-bleeding after larger HA reconstruction and sufficient intrahepatic arterial flow was confirmed by Doppler ultrasound (DUS). In group 2, the median size of donor HAs was smaller (P < 0.001) and the duration of HA reconstruction was longer (P < 0.001). However, there was no significant difference in biliary complication rate, artery complication rate, patient survival, and graft survival. Risk factor analysis revealed that male recipients, bile duct diameter < 5mm, and total duration of operation were risk factors for biliary anastomosis stricture (BAS). Multiple HAs itself and partial reconstruction of multiple HAs were not risk factors of BAS. In conclusion, In pediatric LDLT, partial reconstruction of HAs in a left liver graft with multiple HA stumps does not increase the risk of BAS or affect graft survival when intrahepatic arterial communication is confirmed by pulsatile back-bleeding from the smaller artery and DUS.

CITATION INFORMATION: Lee K, Kim K, Kim S, Lee J, Lee J, Lee N, Cho C, Lee S, Choi G, Kwon C, Joh J.-W, Lee S.-K. Outcome of Partial Reconstruction of Multiple Hepatic Arteries in Pediatric Living Donor Liver Transplantation Using Left Lateral Section Grafts. Am J Transplant. 2016;16 (suppl 3).

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