title: Incidence of hepatic artery variations in liver transplantation: does it really influence short- and long-term results?
abstract: BACKGROUND
  Some variations of hepatic artery, which show 30% incidence, must be taken into account to avoid damage to the liver transplant during harvesting, we analyzed the incidence of variations and their influence on postoperative results.
  
  
  METHODS
  We performed a retrospective study of 325 liver transplantation between 2001 and December 2011.
  
  
  RESULTS
  Variations in the hepatic artery were detected in 91 transplantations (32%) including 29 donors (8.9%), 57 recipients (17.5%), and 5 both (1.5%). The main variation among donors was a right hepatic artery originating from the mesenteric artery (38.2%), and a left hepatic artery from the left gastric artery (35.3%). Recipients showed the same distribution: RHA-UMA (right hepatic artery from upper mesenteric artery) (38.7%) and LHA-LGA (left hepatic artery from left gastric artery) (12.9%). 48.5% of donor hepatic variations did not need bench reconstruction, but all RHA-UMA required it mainly due to the donor gastroduodenal artery (7; 58%) We did not observe significant difference in cold or warm ischemia time, surgical time, red blood cell requirement, postoperative mortality, or overall survival when there was or was not an arterial anomaly. But arterial complications were more frequent in cases where there were recipient anomalies or both versus without anomalies or with donor anomalies (20%, 7,8%, 0%, 5,6%; P = .06). Donor RHA-UMA was associated with worse overall survival (69, 2%; P = .07) and longer cold ischemia time and red blood requirement. Bench reconstruction held to longer cold ischemia time and blood cell requirements (P = .01) and shorter overall survival (82.4%). RHA-UMA was associated (P = .08) with worse actuarial survival and a needed for bench reconstruction (P = .01).
  
  
  CONCLUSIONS
  One must be careful during liver harvest to detect hepatic artery variations to avoid damage. Hepatic artery anomalies do not influence liver transplant results except for the presence of an RHA from the UMA with a need for bench reconstruction.
authors.affiliation: Unit Liver Transplant, Río Hortega University Hospital, Valladolid, Spain. perezsb@hotmail.com
authors.forename: B
authors.initials: B
authors.lastname: Pérez-Saborido
authors.forename: D
authors.initials: D
authors.lastname: Pacheco-Sánchez
authors.forename: A
authors.initials: A
authors.lastname: Barrera Rebollo
authors.forename: P
authors.initials: P
authors.lastname: Pinto Fuentes
authors.forename: E
authors.initials: E
authors.lastname: Asensio Díaz
authors.forename: F
authors.initials: F
authors.lastname: Labarga Rodriguez
authors.forename: J C
authors.initials: JC
authors.lastname: Sarmentero Prieto
authors.forename: R
authors.initials: R
authors.lastname: Martínez Díez
authors.forename: P
authors.initials: P
authors.lastname: Rodríguez Vielba
authors.forename: M
authors.initials: M
authors.lastname: Gonzálo Martín
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez López
authors.forename: A
authors.initials: A
authors.lastname: de Anta Román
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000453:epidemiology* / Q000401:mortality