title: Extra-anatomical hepatic artery reconstruction in living donor liver transplantation: can this procedure save hepatic grafts?
abstract: Graft hepatic arteries (HAs) are usually reconstructed with a recipient HA branch (anatomical HA reconstruction) in living donor liver transplantation (LDLT). Surgeons often encounter difficulties in reconstructing HAs, particularly when a recipient artery other than an HA branch must be used; this is known as extra-anatomical HA reconstruction. The outcomes of LDLT recipients with extra-anatomical HA reconstruction were retrospectively reviewed. Between October 1996 and October 2009, we performed primary LDLT 335 times, re-LDLT 8 times, and HA re-reconstruction 5 times for patients with HA complications. Thirty-three extra-anatomical HA reconstructions were performed in 22 patients with primary LDLT (6.6%), 4 patients with re-LDLT (50%), and 4 patients with HA re-reconstructions for HA complications (80%). In extra-anatomical HA reconstructions, we used 12 right gastroepiploic arteries, 6 right gastric arteries, 5 gastroduodenal arteries, 2 left gastric arteries, 2 splenic arteries, 2 cystic arteries, and 4 interposition grafts as recipient inflow arteries. Only 1 HA-related complication, the formation of an aneurysm, occurred after extra-anatomical HA reconstruction. The overall graft and patient survival probabilities after primary LDLT with extra-anatomical HA reconstruction were comparable to those after LDLT with anatomical HA reconstruction, although approximately half of the patients with extra-anatomical HA reconstruction suffered anastomotic biliary strictures. Therefore, extra-anatomical HA reconstruction can be safely performed through the proper selection of recipient arteries and the use of interposition grafts. These procedures can save hepatic grafts, even when recipient HAs cannot be used as inflow arteries.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. huchi@surg2.med.kyushu-u.ac.jp
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kayashima
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D024405:Gastroepiploic Artery / Q000601:surgery; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D007564:Japan; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013157:Splenic Artery / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult