The Impact of Extra-Anatomical Hepatic Artery Reconstruction during Living Donor Transplantation on Biliary Complications and Graft and Patient Survival

Y. Chung, J. Kim, S. Kim, J. Rhu, S. Lee, K. Lee, S. Lee, G. Choi, J. Park, S. Kim, J. Joh, S. Lee

Transplantation, Samsung Medical Center, Seoul, Korea, Republic of

Meeting: 2019 American Transplant Congress

Abstract number: 230

Keywords: Anastomatic healing, Graft failure, Morbidity, Mortality

Session Information

Session Name: Concurrent Session: Liver Transplant Complications and Retransplantation I

Session Type: Concurrent Session

Date: Monday, June 3, 2019

Session Time: 2:30pm-4:00pm

Presentation Time: 3:30pm-3:42pm

Location: Ballroom A

*Purpose: This study was designed to analyze the feasibility of extra-anatomical hepatic artery reconstruction in living donor liver transplantation.

*Methods: Patients who underwent their first living donor liver transplantation at our center between January 2008 and December 2017 were reviewed. Hepatic artery reconstruction was classified as anatomical or extra-anatomical reconstruction. We compared the background characteristics and post-transplantation outcomes, including complications, biliary complications, graft survival, and overall survival. The potential risk factors for bile leakage was analyzed using multivariable logistic regression while risk factor for biliary stricture-free, graft, and overall survival were analyzed using multivariable Cox regression.

*Results: Among 800 patients, 35 (4.4%) underwent extra-anatomical reconstruction while seven patients (7/35, 20.0%) experienced hepatic artery complications after the initial anatomical reconstruction and required extra-anatomical reconstruction during reoperation. Patients who underwent extra-anatomical reconstruction (n=2/35, 5.7%) had a similar rate of hepatic artery complications compared to those who underwent anatomical reconstruction (n=46/772, 5.9%, P=0.699). Extra-anatomical reconstruction was a significant risk factor of bile leakage (OR=4.167, CI 1.928-9.006, P<0.001) along with multiple bile ducts (OR=1.606, CI=1.022-2.526, P=0.040), and hepaticojejunostomy. (OR=4.108, CI=2.190-7.707, P<0.001) However, extra-anatomical reconstruction had no statistical relationship to biliary stricture-free survival (HR=1.602, CI=0.982-2.613, P=0.059), graft survival (HR=1.745, CI=0.741-4.109, P=0.203), or overall survival (HR=1.405, CI=0.786-2.513, P=0.251). Hepatic artery complications were associated with poor biliary stricture-free survival (HR=2.060, CI=1.329-3.193, P=0.001), graft survival (HR=5.549, CI=2.883-10.681, P<0.001), and overall survival (HR=1.958, CI=1.195-3.206, P=0.008).

*Conclusions: Extra-anatomical hepatic artery reconstruction during living donor liver transplantation was not a risk factor of biliary stricture, graft failure, or overall survival.

To cite this abstract in AMA style:

Chung Y, Kim J, Kim S, Rhu J, Lee S, Lee K, Lee S, Choi G, Park J, Kim S, Joh J, Lee S. The Impact of Extra-Anatomical Hepatic Artery Reconstruction during Living Donor Transplantation on Biliary Complications and Graft and Patient Survival [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-extra-anatomical-hepatic-artery-reconstruction-during-living-donor-transplantation-on-biliary-complications-and-graft-and-patient-survival/. Accessed May 12, 2025.

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