Microvascular reconstruction of the hepatic artery in live donor liver transplantation: experience across a decade.
OBJECTIVE
Hepatic arterial anastomosis by means of a microvascular technique can be performed with a high success rate in live donor liver transplantation in adult recipients.


METHODS
Retrospective analysis of data collected prospectively.


METHODS
Tertiary referral center.


METHODS
From September 28, 1993, through December 23, 2002, 28 children received left lateral segment grafts (n = 23) or left lobe grafts (n = 5), and 124 adults received left lobe (n = 6) or right lobe (n = 118) grafts. Microvascular technique was used for hepatic arterial anastomosis. Attention was paid to exposure, orientation of the axis of arterial ends, and matching of size. Long microinstruments were used for arterial ends deeply located inside an adult's abdominal cavity. An average of 16 stitches was used for a vessel anastomosis 3 mm in diameter.


METHODS
Intraoperative and postoperative Doppler ultrasonography were performed.


METHODS
Hepatic artery thrombosis rate.


RESULTS
All hepatic arterial anastomoses were patent after reconstruction. Complications occurred in 3 patients. They had hepatic arterial thrombosis at 19 days, 25 days, and 3 months after liver transplantation. The overall complication rate was 2%.


CONCLUSIONS
With attention to exposure, appropriate instruments, and experience, a low complication rate of 2% can be achieved in hepatic arterial anastomosis by using a microvascular technique, even in adult patients with the liver graft situated deeply in the abdominal cavity.
Wei
William Ignace
WI
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, People's Republic of China.
Lam
Lai-Kun
LK
Ng
Raymond Wai-Man
RW
Liu
Chi-Leung
CL
Lo
Chung-Mau
CM
Fan
Sheung-Tat
ST
Wong
John
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler