Hepatic artery microvascular anastomosis in pediatric living donor liver transplantation: a review of 35 consecutive cases by a single microvascular surgeon.
Early experience with living donor liver transplantation (LDLT) was often complicated by hepatic artery thrombosis (HAT), a devastating complication resulting in graft loss. Attempting to reduce the incidence of HAT, we undertook a retrospective review of all children at our institution undergoing LDLT between March 2000 and August 2007, with the hepatic artery anastomosis performed by a single microvascular surgeon. Transplant surgeons performed the remainder of the operation. Patient outcomes were evaluated, including 1-year arterial and biliary complications, as well as overall survival. End-to-end hepatic arterial anastomoses were performed in 35 patients (median age: 15 months). Median posttransplant follow-up was 39 months (range: 0 to 90 months). One patient with a diffuse coagulopathy was retransplanted for HAT; this patient also demonstrated portal and hepatic vein thromboses. Biliary complications occurred in seven patients: three leaks, one cholangitis, one nonspecific dilatation, and two strictures. The median posttransplant follow-up was 39 months (range: 0 to 90 months). One- and 5-year patient survival was 94% and 94%, respectively. Very low rates of HAT can be achieved with LDLT using microsurgical techniques for hepatic arterial anastomoses. Outstanding long-term liver graft function can be achieved after LDLT when plastic surgeons and transplant surgeons collaborate together to reduce technical complications.
Panossian
Andre
A
Children's Hospital Los Angeles-Plastic Surgery, Los Angeles, California 90027, USA. apanossian@chla.usc.edu
Diamond
Ivan
I
Fecteau
Annie
A
Grant
David
D
Zuker
Ronald
R
D000293:Adolescent; D000714:Anastomosis, Surgical; D001656:Biliary Atresia / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008866:Microsurgery; D011183:Postoperative Complications / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control