Complications of arterial reconstruction in living donor liver transplantation: a single-center experience.
OBJECTIVE
Microsurgical reconstruction of the fine hepatic arteries (HA) reduces the chance of complications in living donor liver transplantation (LDLT). We reviewed HA reconstructions and analyzed their complications and treatment in a single center.


METHODS
Between August 1996 and September 2004, we performed LDLT on 71 adults and 19 children. Patients received a lateral segment graft (n = 16), a left lobe graft (n = 11), an extended left lobe graft (n = 12), or a right lobe graft (n = 51).


RESULTS
Hepatic artery reconstruction was performed by end-to-end anastomosis under an operating microscope in all except five adults who received right lobe grafts with loupe magnification. Arterial complications developed in 5 (5.6%) of the 90 patients. Three patients required reanastomosis during their primary operation because of HA thrombosis, anastomotic kinking, and stenosis, respectively. There were three postoperative complications: an anastomotic stenosis, revised by percutaneous transluminal angioplasty; rupture of an HA pseudoaneurysm, treated by embolization; and anastomotic kinking, revised by reanastomosis. The patient with the pseudoaneurysm died of arterial complications. Multivariate analysis of cases before (4/13, 30.8%) and after 2000 (1/77, 1.3%) revealed that surgical experience was the only significant factor in reducing the incidence of HA complications (P = 0.007).


CONCLUSIONS
Case number-dependent anastomotic reliability using microsurgical techniques is important for safer arterial reconstruction.
Division of Abdominal Transplant, Department of Surgery, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
Hiroaki
H
Matsuda
Takahito
T
Yagi
Hiroshi
H
Sadamori
Hiroyoshi
H
Matsukawa
Susumu
S
Shinoura
Hiroshi
H
Murata
Yuzo
Y
Umeda
Noriaki
N
Tanaka
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation