title: The role of complex hepatic artery reconstruction in orthotopic liver transplantation.
abstract: The goal of this study was to analyze the influence of multiple anastomosis on outcome in orthotopic liver transplantation (OLT) and its implications for split-liver and living related liver transplantation programs. In a retrospective study, 683 first OLTs in adults were analyzed. Complex hepatic artery reconstruction was defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries. OLT was performed in a standard manner. All patients had daily ultrasound examination. In this series we found 72 grafts (10.5%) with anatomic arterial variations that required complex hepatic artery reconstruction. There was no difference in primary organ function and demographic data compared with patients with simple arterial reconstruction. However, hepatic artery thrombosis (HAT) occurred in 9.7% of patients (7 of 72) with complex reconstruction in contrast to 2.0% in the control group (12 of 638; P <.001). Statistical analysis identified multiple anastomoses (P <.002) and primary nonfunction (P <.02) as significant risk factors for HAT. Three patients underwent successful thrombectomy for HAT, all others had to undergo retransplantation. Although in the group with complex arterial reconstruction increased graft loss caused by HAT was found early postoperatively, the overall 5-year patient and graft survival was not different for both groups. Although complex reconstruction is a risk factor for HAT, early diagnosis of HAT by daily ultrasound and early repeat OLT can provide similar 5-year survival as for patients with simple reconstruction. We conclude that complex hepatic artery reconstruction challenges conventional OLT as well as split-liver and living related liver transplantation, but does not necessarily affect its long-term outcome.
authors.affiliation: University of Vienna, Department of Surgery, Division of Transplantation, Waehringer Guertel 18-20, 1090 Vienna, Austria. thomas.soliman@akh-wein.ac.at
authors.forename: Thomas
authors.initials: T
authors.lastname: Soliman
authors.forename: Martin
authors.initials: M
authors.lastname: Bodingbauer
authors.forename: Felix
authors.initials: F
authors.lastname: Langer
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Berlakovich
authors.forename: Peter
authors.initials: P
authors.lastname: Wamser
authors.forename: Susanne
authors.initials: S
authors.lastname: Rockenschaub
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Muehlbacher
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steininger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000401:mortality