Dual hepatic artery reconstruction in living donor liver transplantation using a left hepatic graft with 2 hepatic arterial stumps.
BACKGROUND
A left hepatic graft in living donor liver transplantation (LDLT) often has 2 thin and short hepatic arterial stumps, which makes hepatic artery (HA) reconstructions much more difficult to perform. Consequently, some investigators regard using a left graft as a contraindication to LDLT, whereas others report that the reconstruction of only 1 HA is sufficient for most LDLTs. The aim of this retrospective study was to investigate whether 2 HAs on a left hepatic graft in an LDLT can be reconstructed safely and whether the outcomes of LDLTs are affected by reconstructing both HAs (dual reconstruction).


METHODS
A total of 175 LDLTs using a left graft between October 1996 and April 2008 were divided into 3 groups: group 1 (n = 104): 1 HA stump with 1 HA reconstruction; group 2 (n = 47): 2 HA stumps with dual HA reconstruction; and group 3 (n = 24): 2 HA stumps with only 1 HA reconstruction. We reconstructed HAs using microvascular surgical techniques.


RESULTS
With technical advancement, we have been able to reconstruct both HAs in most cases without any HA-related complications, despite the fact that complex HA reconstructions were needed. Group 3 patients had a significantly greater incidence of anastomotic biliary stricture, which was decreased by dual HA reconstructions to the same level as observed in group 1.


CONCLUSIONS
Dual HA reconstructions can be performed safely in LDLTs with a decreased incidence of anastomotic biliary stricture.
Uchiyama
Hideaki
H
Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan. huchi@surg2.med.kyushu-u.ac.jp
Harada
Noboru
N
Sanefuji
Kensaku
K
Kayashima
Hiroto
H
Taketomi
Akinobu
A
Soejima
Yuji
Y
Ikegami
Toru
T
Shimada
Mitsuo
M
Maehara
Yoshihiko
Y
D000328:Adult; D001787:Blood Group Incompatibility; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006499:Hepatic Artery / Q000002:abnormalities / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed