title: Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons.
abstract: 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.
authors.affiliation: 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.
authors.forename: Sheng
authors.initials: S
authors.lastname: Yan
authors.forename: Qi-Yi
authors.initials: QY
authors.lastname: Zhang
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Yu
authors.forename: Jiang-Juan
authors.initials: JJ
authors.lastname: He
authors.forename: Wei-Lin
authors.initials: WL
authors.lastname: Wang
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Shen
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: 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