title: Microscope-assisted hepatic artery reconstruction in adult living donor liver transplantation-A review of 325 consecutive cases in a single center.
abstract: Despite the technical and medical improvements in the recent years, hepatic artery thrombosis (HAT) remains a devastating complication after living donor liver transplantation (LDLT). We described our surgical techniques and monitoring protocols for hepatic artery reconstruction. We reported one of the lowest incidence rates of HAT in the literature.
  
  
  
  Between 2008 and 2015, a total of 325 LDLTs performed at our institute were retrospectively analyzed. Under microscope assistance, all hepatic artery anastomosis were performed in a risk-free and back-wall first manner. We collected donors' and recipients' demographics, operative procedures, and outcome.
  
  
  
  A total of 325 adult LDLTs were enrolled in the study. Of these, 297(91.4%) were right liver graft. The mean diameter of the hepatic arteries of the graft was 1.9 ± 0.3 mm. A single HA anastomosis was performed in 310 patients (95.4%). The 1-, 3-, and 5-year overall patient survival rates were 84.8%, 76.8%, and 75.2%, respectively. Only one (0.3%) episode of HAT was encountered in our series. The patient was treated successfully with nonsurgical management.
  
  
  
  Our study showed that the occurrence of HAT is avoidable. Identifying risk factors associated with HAT, meticulous surgical techniques, and careful routine flow monitoring are mandatory to avoid disastrous complications.
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Chen-Fang
authors.initials: CF
authors.lastname: Lee
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Johnny Chuieng-Yi
authors.initials: JC
authors.lastname: Lu
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|Assiut University Hospital, Assiut, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zidan
authors.affiliation: Department of Gastroenterology, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Ching-Song
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Kun-Ming
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: complications; hepatic artery reconstruction; hepatic artery thrombosis; liver transplantation; microscope