title: Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques.
abstract: Split liver transplantation (SLT) compensates for the organ shortage and provides an alternative solution for recipients disadvantaged by a smaller body size. Variations in the hepatic arterial anatomy and reconstructive techniques may lead to more technical complications, and we sought to analyze the incidence and risk factors of vasculobiliary complications with respect to reconstructive techniques. We identified 171 adult right lobe SLT procedures and 1412 whole liver transplantation (WLT) procedures between January 2000 and June 2012 and compared the results of these 2 groups. In the SLT group, arterial reconstruction techniques were classified into 4 subgroups (I-IV), and biliary reconstruction was classified into 2 groups [duct-to-duct (DD) anastomosis and Roux-en-Y hepaticojejunostomy (RH)]. Specific surgical complications were analyzed against reconstruction techniques. The overall incidence of vascular and biliary complications in the SLT group was greater than that in the WLT group (P = 0.009 and P = 0.001, respectively). There was no difference in hepatic artery thrombosis (HAT), but we saw a tendency toward early HAT in the presence of multiple hepatic arteries supplying the right lobe graft (group IV; 20%) in comparison with the other arterial reconstruction groups (P = 0.052). No difference was noticed in the overall incidence of biliary complications in either DD or RH recipients across 4 arterial reconstruction groups. When the arterial reconstruction involved a right hepatic artery (groups II and III) combined with a DD biliary anastomosis, there was a significant preponderance of biliary complications (P = 0.04 and P = 0.01, respectively). There was no survival difference between SLT and WLT grafts. In conclusion, the complications of SLT are directly related to arterial and biliary reconstruction techniques, and this classification helps to identify high-risk reconstructive techniques.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Moustafa
authors.initials: M
authors.lastname: Mabrouk Mourad
authors.forename: Christos
authors.initials: C
authors.lastname: Liossis
authors.forename: Senthil
authors.initials: S
authors.lastname: Kumar
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.forename: M
authors.initials: M
authors.lastname: Thamara P R Perera
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000453:epidemiology; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D004739:England; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007582:Jejunostomy / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality