Microsurgical hepatic artery reconstruction in paediatric liver transplantation.
OBJECTIVE
Hepatic artery thrombosis is a serious complication of paediatric liver transplantation often leading to retransplantation. It is also associated with decreased patient survival rates. In 1999 microsurgical hepatic artery reconstruction by Plastic and Reconstructive Surgeons was introduced to the Queensland Liver Transplant Service at the Royal Children's Hospital, Brisbane, in an attempt to decrease hepatic artery complications.


METHODS
A review of the computerised database of the Queensland Liver Transplant Service was undertaken. Between March 1985 and December 2005, 252 transplants were performed without microsurgery. Since December 1999, 23 transplants were performed with microsurgical hepatic artery reconstruction by Plastic and Reconstructive Surgeons using the operating microscope.


RESULTS
There were a total of 28 cases of hepatic artery thrombosis in 275 transplants. Survival for patients with hepatic artery thrombosis was significantly worse than for patients without (one year survival rate 61.5% versus 83.6%, p = 0.0065). The microsurgery group had a lower incidence of hepatic artery thrombosis (4.3% versus 10.7%, p = 0.29), a lower retransplantation rate (4.3% versus 9.1%, p = 0.38) and increased one year patient survival (91.3% versus 79.7%, p = 0.31).


CONCLUSIONS
Microsurgical hepatic artery reconstruction in paediatric liver transplantation may decrease hepatic artery thrombosis rates, decrease retransplantation rates and improve survival.
Bade
Stuart A
SA
Department of Plastic and Reconstructive Surgery, Royal Children's Hospital, Brisbane, Queensland, Australia.
Bayley
Gerard J
GJ
Coren
Robert A
RA
Emmett
James A
JA
Fawcett
Jonathan
J
Kane
Anthony J
AJ
Vlynch
Stephen
S
Mcdermant
Greg R
GR
Richardson
Phillip W F
PW
Theile
David R B
DR
Theile
Richard J
RJ
D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013927:Thrombosis / Q000517:prevention & control