title: Hepatic arterial complications in adult living donor liver transplant recipients: a single-center experience of 673 cases.
abstract: BACKGROUND
  Hepatic arterial reconstruction during living donor liver transplantation (LDLT) is a very delicate and technically complicated procedure. Post-LDLT hepatic arterial complications are associated with significant morbidity and mortality.
  
  
  METHODS
  We retrospectively analyzed the details of post-operative hepatic arterial complications in 673 consecutive adult LDLT recipients between January 1996 and September 2009.
  
  
  RESULTS
  Hepatic arterial complications occurred in 43 of 673 adult recipients (6.4%) within a median of 13 post-transplant days (range, 1-63). These included hepatic artery thrombosis (including anastomotic stenosis) in 33 cases, anastomotic bleeding in seven cases, and rupture of anastomotic aneurysm in three cases. To treat these complications, surgical re-anastomosis was performed in 26 cases, while the other 17 cases underwent conservative therapies, including four angioplasties by interventional radiology. Biliary complications after hepatic arterial complications occurred in 17 cases. The overall survival rate after LDLT was significantly lower in the hepatic arterial complication group compared with that in the non-complication group (60.7% vs. 80.1% at one yr, 44.3% vs. 74.2% at five yr, respectively; p < 0.001). Multivariate analysis showed that the extra-anatomical anastomosis (p = 0.011) was the only independent risk factor for hepatic arterial complications.
  
  
  CONCLUSIONS
  Because hepatic arterial complications after LDLT are associated with poor patient survival, early diagnosis and immediate treatment are crucial. The anatomical anastomosis may be the first choice for the hepatic arterial reconstruction to the extent possible.
authors: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: T
authors: T
authors: Iida
authors: T
authors: T
authors: Kaido
authors: S
authors: S
authors: Yagi
authors: T
authors: T
authors: Hori
authors: Y
authors: Y
authors: Uchida
authors: K
authors: K
authors: Jobara
authors: H
authors: H
authors: Tanaka
authors: S
authors: S
authors: Sakamoto
authors: M
authors: M
authors: Kasahara
authors: K
authors: K
authors: Ogawa
authors: Y
authors: Y
authors: Ogura
authors: A
authors: A
authors: Mori
authors: S
authors: S
authors: Uemoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D066027:Transplant Recipients; D055815:Young Adult
keywords: hepatic arterial complications; hepatic arterial thrombosis; living donor liver transplantation