Background

Reconstruction of the hepatic artery is technically challenging in living donor liver transplantation (LDLT). We describe outcomes of a safe and easily teachable technique.

Methods

A prospectively maintained database was used to analyse the incidence of hepatic arterial complications in 675 liver transplants performed from March 2007 to April 2016 across two institutions.

Results

From March 2007 to April 2016, 675 liver transplants were performed, 28 deceased donor liver transplants and the rest LDLTs. The majority of the LDLTs (85.5%) utilized right lobes. In-hospital mortality was 9%.

From March 2007 to August 2010, 443 liver transplants were performed using a standard technique with interrupted 7.0 polypropylene sutures under magnifying loupes for artery reconstruction. From September 2010 onwards, the 'W' technique described previously was instituted^1,2.

Hepatic artery thrombosis (HAT) occurred in 9 of the 443 (2%) standard techniques and 2 (0.8%) of the 'W' group.

Of the 9 HATs in the standard group, 1 maintained normal liver functions. Surgical reconstruction was attempted in 8 cases and was successful in 7. The patient with unsuccessful reconstruction underwent a re-transplant. One of the 7 had re-thrombosis of the hepatic artery and underwent re-transplant. Of the 6 patients who maintained patent hepatic arteries, 2 died of sepsis while the remaining 4 had long term survival. Graft loss due to HAT was 4 cases (0.9%)

Of the 2 HATs in the 'W' group, 1 occurred in a patient with overwhelming sepsis on high doses of vasopressors. The second case was an asymptomatic HAT in the second week after transplant. Graft loss (1 case-0.4%) was probably not due to hepatic artery thrombosis.

Conclusion

The 'W' technique is a safe, reproducible and easily teachable technique for reconstruction of the hepatic artery in liver transplantation with a low rate of graft loss due to HAT.

References

1. Kumaran V, Kapoor S, Nath B, Shah AJ, Pawar T, Varma V. A safe and reproducible technique for performing the hepatic arterial anastomosis in living donor liver transplantation: the “W” technique. Liver Transplantation 2014; 20 (6 Suppl. 1): S365.

2. Nath B, Mehta N, Kumaran V. Living Donor Liver Transplant: Implantation of the Graft. In Techniques of Liver Surgery. Kumaran V. Jaypee Brothers Medical Publishers (P) Ltd. New Delhi 2016: 1st edition: 125-138.

CITATION INFORMATION: Kumaran V, Varma V, Kapoor S, Nath B, Chauhan A, Sable S, Yadav K, Kumar S, Sharma S. The 'W' Technique: A Safe and Reproducible Technique for Hepatic Arterial Reconstruction in Living Donor Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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