title: Hepatic artery reconstruction in living donor liver transplantation: risk factor analysis of complication and a role of MDCT scan for detecting anastomotic stricture.
abstract: BACKGROUND
  In partial liver transplantation, reconstruction of the hepatic artery is technically highly demanding and the incidence of arterial complications is high. We attempted to identify the risk factors for anastomotic complications after hepatic artery reconstruction and examined the role of multidetector-row computed tomography (MDCT) in the evaluation of the reconstructed hepatic artery in liver transplant recipients.
  
  
  METHODS
  A total of 109 adult-to-adult living donor liver transplantations (LDLT) were performed at our institute between 1999 and July 2011. Hepatic artery reconstruction was performed under a surgical microscope (MS group, n = 84), until we began to adopt surgical loupes (4.5×) for arterial reconstructions in all cases after January 2009 (SL group, n = 25). A dynamic MDCT study was prospectively carried out on postoperative days 7, 14, and 28, and at postoperative month 3, 6, and 12 after April 2005 (n = 60).
  
  
  RESULTS
  There were no cases of hepatic artery thrombosis and six cases (5.5 %) of interventional radiology-confirmed hepatic artery stenosis (HAS). Risk factor analysis for HAS showed that ABO-incompatible LDLT was associated with HAS. Use of surgical loupes provided superior results as compared to anastomosis under a surgical microscope, and it also provided the advantage of reduced operative time. The MDCT procedure was useful for detecting HAS; however, the false positive rate was relatively high until 3 months after the LDLT (100 % sensitivity and 72.8 % specificity at 3 months).
  
  
  CONCLUSIONS
  Hepatic arterial anastomosis using surgical loupes tended to be time-saving and to yield similar or better results than traditional microscope-anastomosis. The use of MDCT aided the diagnosis of HAS, although the substantial false positive rate should be borne in mind in clinical practice.
authors: Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan, smarubashi@gesurg.med.osaka-u.ac.jp.
authors: Shigeru
authors: S
authors: Marubashi
authors: Shogo
authors: S
authors: Kobayashi
authors: Hiroshi
authors: H
authors: Wada
authors: Koichi
authors: K
authors: Kawamoto
authors: Hidetoshi
authors: H
authors: Eguchi
authors: Yuichiro
authors: Y
authors: Doki
authors: Masaki
authors: M
authors: Mori
authors: Hiroaki
authors: H
authors: Nagano
mesh_terms: D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
references: Pediatr Transplant. 2010 Feb;14(1):48-51
references: 19656321
references: J Clin Ultrasound. 2007 Nov-Dec;35(9):483-90
references: 17583559
references: Clin Transplant. 2011 Nov-Dec;25(6):929-38
references: 21954993
references: Transplantation. 1992 Aug;54(2):263-8
references: 1496539
references: Ann Surg. 2000 Jul;232(1):104-11
references: 10862202
references: Ann Transplant. 2011 Oct-Dec;16(4):12-5
references: 22210416
references: AJR Am J Roentgenol. 2009 Jul;193(1):128-35
references: 19542404
references: Transplant Proc. 2007 Dec;39(10):3239-44
references: 18089363
references: Arch Surg. 2004 Mar;139(3):304-7
references: 15006889
references: Surgery. 2011 Jun;149(6):841-5
references: 21316724
references: Transplant Proc. 2004 Nov;36(9):2771-3
references: 15621145
references: Ultrasound Q. 2011 Mar;27(1):49-54
references: 21343801
references: J Clin Ultrasound. 2003 Sep;31(7):339-45
references: 12923877
references: Transplantation. 1997 Jan 27;63(2):250-5
references: 9020326
references: Transpl Int. 2007 Nov;20(11):970-3
references: 17635836
references: Transplant Proc. 2012 Mar;44(2):448-50
references: 22410040
references: Transplantation. 1997 Nov 15;64(9):1295-9
references: 9371671
references: Radiology. 2011 Sep;260(3):884-91
references: 21734158
references: Clin Radiol. 2002 Sep;57(9):789-99
references: 12384104
references: Abdom Imaging. 2007 Sep-Oct;32(5):635-43
references: 17013690
references: J Hepatobiliary Pancreat Surg. 2006;13(2):105-9
references: 16547670
references: Ann Surg. 1993 Jan;217(1):82-91
references: 8424706
references: Surgery. 2002 Jan;131(1 Suppl):S200-4
references: 11821811
references: World J Gastroenterol. 2010 Jun 7;16(21):2682-8
references: 20518092