Low incidence of hepatic artery thrombosis after hepatic artery reconstruction during liver transplantation.
BACKGROUND
Hepatic artery thrombosis (HAT) remains an important cause of graft loss after liver transplantation. HAT can be caused by technical, hemodynamic, or immunologic factors. Bench reconstruction of anatomical variants of the hepatic artery is considered to fore a major risk related to HAT. The purpose of the study was to analyze the influence on HAT of hepatic artery vascular reconstruction.


METHODS
We retrospectively analyzed 341 donor forms completed between January 2004 and December 2007. Vascular reconstruction was defined as an additional anastomosis between donor hepatic arteries, which was required to fully revascularize the graft. Any incident of HAT was confirmed by angiography and intraoperatively during retransplantation. Fisher's exact test and 95% confidence intervals (CI) were applied for statistical analysis.


RESULTS
Among 341 grafts hepatic artery anomalies observed, variations were recorded in 92 cases (26.9%), of whom 35.9% required hepatic artery reconstruction. HAT was diagnosed in 3% (1/33) hepatic reconstructions (CI, 0.1%-15.8%) compared with 1.6% of grafts (5/308) that did not required hepatic reconstruction (P < or = .45). The 1 case of hepatic thrombosis (1/59) accounting for 1.6% among the group with hepatic anomalies without reconstruction (CI, 0.04%-9.1%).


CONCLUSIONS
A single hepatic reconstruction was a nonsignificant factor for HAT. Hepatic artery reconstruction did not increase the risk of HAT compared with the normal blood supply. Hepatic artery anomalies did not significantly increase the incidence of HAT compared with the group of patients without arterial variations.
Kornasiewicz
O
O
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland. oskar.kornasiewicz@gmail.com
Dudek
K
K
Lewandowski
Z
Z
Grat
Z M
ZM
Scibisz
A
A
Nyckowski
P
P
Krawczyk
M
M
D002102:Cadaver; D006499:Hepatic Artery / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000033:anatomy & histology; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology; D014019:Tissue Donors