Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons.
BACKGROUND
Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe.


METHODS
We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon.


RESULTS
The rate of HA thrombosis was 2% (2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test.


CONCLUSIONS
HA reconstruction without clamping the graft artery is a feasible and simplified technique, which can be mastered by transplant surgeons with considerable microsurgical training.
Yan
Sheng
S
Division of Hepatobiliary and Pancreatic Surgery, Ministry of Public Health; and Key Laboratory of Organ Transplantation Zhejiang Province, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhang
Qi-Yi
QY
Yu
Yu-Sheng
YS
He
Jiang-Juan
JJ
Wang
Wei-Lin
WL
Zhang
Min
M
Shen
Yan
Y
Wu
Jian
J
Xu
Xiao
X
Zheng
Shu-Sen
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; 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 / Q000009:adverse effects; D008875:Middle Aged; D009336:Necrosis; D013927:Thrombosis / Q000209:etiology / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult