title: Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with monosegmental grafts.
abstract: OBJECTIVE
  When living donor liver transplantation (LDLT) is performed on small infant patients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT.
  
  
  METHODS
  Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient's abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion.
  
  
  RESULTS
  Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 ± 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 ± 0.4 and 1.9 ± 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001).
  
  
  CONCLUSIONS
  Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan. yuki371@jichi.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.affiliation: Center for Development of Advanced Medical Technology, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Hishikawa
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Katano
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Hirata
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
mesh_terms: D034841:Abdominal Cavity; D000714:Anastomosis, Surgical; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Branch patch technique; Graft to recipient diameter ratio; Hepatic arterial reconstruction; Monosegmental graft; Pediatric living donor liver transplantation