title: Right gastroepiploic artery as an alternative for arterial reconstruction in living donor liver transplantation.
abstract: Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.
authors.affiliation: Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil.
authors.forename: Klaus
authors.initials: K
authors.lastname: Steinbrück
authors.affiliation: Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil ; Transplantation Unit, São Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfim 1033, 20530-190 Rio de Janeiro, RJ, Brazil.
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Fernandes
authors.affiliation: General Surgery Department, Ipanema Federal Hospital-Health Ministry, Rua Antônio Parreiras 67/69, 22411-020 Rio de Janeiro, RJ, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Enne
authors.affiliation: Transplantation Unit, São Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfim 1033, 20530-190 Rio de Janeiro, RJ, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Vasconcelos
authors.affiliation: Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil ; Transplantation Unit, São Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfim 1033, 20530-190 Rio de Janeiro, RJ, Brazil.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bento
authors.affiliation: Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil ; Transplantation Unit, São Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfim 1033, 20530-190 Rio de Janeiro, RJ, Brazil.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Stoduto
authors.affiliation: Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil.
authors.forename: Thomas
authors.initials: T
authors.lastname: Auel
authors.affiliation: Transplantation Unit, São Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfim 1033, 20530-190 Rio de Janeiro, RJ, Brazil.
authors.forename: Lúcio Filgueiras
authors.initials: LF
authors.lastname: Pacheco-Moreira