title: Hepatic artery reconstruction in living donor liver transplantation: running suture under surgical loupes by cardiovascular surgeons in 180 recipients.
abstract: OBJECTIVE
  The aim of our study was to retrospectively investigate the outcomes of hepatic artery (HA) reconstruction by cardiovascular surgeons in adult-to-adult living donor liver transplantation (A-A LDLT).
  
  
  METHODS
  From April 2007 to April 2011, 187 recipients underwent A-A LDLT. After excluding seven ABO-incompatible transplant recipients, we reviewed the courses of 180 patients including 125 men and 55 women of mean age 52.5±9.2 years (range=23-71). One hundred seventy-seven patients received right-lobe grafts with inclusion of middle hepatic vein (MHV); two, right-lobe grafts without MHV; and one, left-lobe graft. A continuous, single-stitch, running suture with the parachute technique was used for HA reconstruction. The anastomosis was performed by cardiovascular surgeons employing surgical loupes with 4.5× magnification.
  
  
  RESULTS
  The mean time for an arterial reconstruction was 10.7±4.0 minutes (median=10, range=4-30). Hepatic arterial thrombosis (HAT) was encountered in 3 (1.66%) patients. One HAT that developed on postoperative day 1 was successfully rescued by the intra-arterial infusion of urokinase. Another patient required reoperation due to a redundant kinked HA. A third HAT patient underwent successful retransplantation with a cadaveric graft on postoperative day 6. In our series, no delayed HAT was detected and no recipient deaths were related to HAT.
  
  
  CONCLUSIONS
  HA reconstruction with a running suture under surgical loupes is a feasible technique in A-A LDLT. A speedy reconstruction can be performed by an experienced cardiovascular surgeon with a low incidence of HAT.
authors.affiliation: Organ Transplantation Center, Department of Surgery, China Medical University, Taichung, Taiwan.
authors.forename: P-C
authors.initials: PC
authors.lastname: Li
authors.forename: L-B
authors.initials: LB
authors.lastname: Jeng
authors.forename: H-R
authors.initials: HR
authors.lastname: Yang
authors.forename: C-C
authors.initials: CC
authors.lastname: Lee
authors.forename: K-S
authors.initials: KS
authors.lastname: Poon
authors.forename: T-H
authors.initials: TH
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Yeh
authors.forename: H-C
authors.initials: HC
authors.lastname: Lai
authors.forename: W-P
authors.initials: WP
authors.lastname: Su
authors.forename: C Y
authors.initials: CY
authors.lastname: Peng
authors.forename: Y-F
authors.initials: YF
authors.lastname: Chen
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D013624:Taiwan; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult