*Purpose: The recipient GDA is often ligated before the HA anastomosis during OLT either to gain mobility, length on recipient HA and with hypothesis that it would prevent “Steal syndrome” protecting the anastomosis. The aim of study is to evaluate its impact on prevention of HA thrombosis (HAT) and consequences of such ligation.

*Methods: A retrospective analysis of cadaveric OLT (n=210) performed at a tertiary care center between 2016 and 2020 comparing the cases where recipient GDA was ligated (Group 1) or not (Group 2). Impact was evaluated by occurrence of HAT and consequences by post-operative hyperamylasemia (POHA), nausea and vomiting and delayed feeding. Continuous variables were compared using student’s t-test and categorical variables were compared using Pearson’s chi-squared test.

*Results: Out of the 210 patients who underwent liver transplant, Group 1 consisted of 78 recipients where GDA was ligated, and common hepatic artery was used for arterial anastomosis. Group 2 consisted of 132 cases where recipient GDA was not ligated and the anastomosis was performed using either the right hepatic artery or the proper hepatic artery. In 165 cases there were no replaced or accessory vessels, 28 cases had right replaced/accessory, 16 had left replaced/accessory and one case had both right and left replaced/accessory vessel. There was no incidence of hepatic artery thrombosis reported in either of the groups. Out of the 78 cases where GDA was ligated, 31 patients (47%) were reported to have hyperamylasemia ranging between 200 and 4700 and accompanied by delayed feeding, whereas 30 out of 132 cases (25.4%) where GDA was not ligated had hyperamylasemia ranging between 200-1400, p-value 0.003. 19 patients (24.4%) in Group 1 required tube feeds as compared to 14 patients (10.6%) in Group 2, p-value 0.01. 38 patients ( 4.7%) in Group 1 reported nausea and vomiting in the immediate post-operative phase as compared to 17 patients (12.9%) in group 2, p-value 0.001. Feeding was delayed in 23 patients (29.5%) in Group 1 as compared to 9 patients (6.8%) in Group 2, p-value 0.001. (Table 1)

*Conclusions: Ligation of recipient GDA is not associated with decreased risk of HAT as compared to non-ligation. However, it does have consequences in the form of possible POHA leading to delayed feeding due to decreased oral tolerance.

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