Background: Microsurgery was introduced into living donor liver transplantation (LDLT) in 1990 and since then it has gained worldwide recognition for effectiveness in small hepatic artery (HA) reconstruction. In this study we present arterial outcomes using this technique in 342 consecutive LDLTs.
Patients and Methods: 345 LDLTs were performed in Kumamoto University from September 2000 to October 2012. Among those, 342 LDLTs were enrolled in this study excluding three recipients who died within one day after transplantation. Microsurgical techniques were used for HA reconstruction in all cases. There were 117 pediatric (under 16 years old) and 225 adult cases. Hepatic artery thrombosis (HAT) was defined as the failure to detect an arterial signal by Doppler ultrasound study and/or non-visualization of the HA using enhanced CT scan.
Results: Five cases of HAT (2.3%) developed between POD 3 and 40 (median: 4.5). Only one pediatric patient experienced HAT, a 2-year-old in whom re-anastomosis was successfully performed on POD 3. In 7 other adult cases, two were observed without treatment and two underwent thrombolysis by HA catheterization via the celiac trunk. Re-anastomosis was performed in the remaining 3 cases. All recipients with HAT survived without serious complications except an adult who developed HAT on POD 40 and died of multiple liver abscesses. Bleeding from the HA developed in 5 patients (1.5%) between POD 4 and 58 (median: 12). These cases included a 14-year-old boy who suffered rupture of the arterial wall proximal to the anastomotic site due to fungal infection. He died after retransplantation. The four other cases were adults. Two experienced rupture of the hepatic artery and two gastrointestinal bleeding due to HA pseudoaneurysm. Only one recipient with bleeding survived, a patient with a pseudoaneurysm who underwent successful HA reconstruction using a jump graft of autologous inferior mesenteric artery.
Conclusions: The use of routine microsurgical techniques was associated with a very low incidence of HA complications, especially in pediatric cases. Results of re-anastomosis were satisfactory. In contrast, bleeding from HA was associated with a higher incidence of death. Microsurgical hepatic artery reconstruction should be considered in cases of LDLT.
To cite this abstract in AMA style:Asonuma K, Hayashida S, Honda M, Takeichi T, Yamamoto H, Lee K, Ohya Y, Murokawa T, Inomata Y. Routine Use of Microsurgical Techniques To Minimize Hepatic Arterial Complications in 342 Consecutive Living Donor Liver Transplants [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/routine-use-of-microsurgical-techniques-to-minimize-hepatic-arterial-complications-in-342-consecutive-living-donor-liver-transplants/. Accessed January 18, 2021.
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