Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jun 7, 2010; 16(21): 2682-2688
Published online Jun 7, 2010. doi: 10.3748/wjg.v16.i21.2682
Microsurgical reconstruction of hepatic artery in A-A LDLT: 124 consecutive cases without HAT
Yi Yang, Lu-Nan Yan, Ji-Chun Zhao, Yu-Kui Ma, Bin Huang, Bo Li, Tian-Fu Wen, Wen-Tao Wang, Ming-Qing Xu, Jia-Yin Yang
Yi Yang, Lu-Nan Yan, Ji-Chun Zhao, Yu-Kui Ma, Bin Huang, Bo Li, Tian-Fu Wen, Wen-Tao Wang, Ming-Qing Xu, Jia-Yin Yang, Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Yan LN and Zhao JC contributed equally to this work; Yan LN, Zhao JC and Yang Y designed the research; Zhao JC, Ma YK, Huang B and Yang Y contributed to reconstruction of the hepatic artery; Li B, Wen TF, Wang WT, Xu MQ and Yang JY contributed to clinical A-A LDLT work; Yang Y wrote the manuscript; Zhao JC and Yan LN reviewed the manuscript.
Correspondence to: Lu-Nan Yan, MD, PhD, Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. yanlunan120@126.com
Telephone: +86-28-85422469 Fax: +86-28-85422469
Received: January 7, 2010
Revised: February 23, 2010
Accepted: March 2, 2010
Published online: June 7, 2010
Abstract

AIM: To retrospectively investigate microsurgical hepatic artery (HA) reconstruction and management of hepatic thrombosis in adult-to-adult living donor liver transplantation (A-A LDLT).

METHODS: From January 2001 to September 2009, 182 recipients with end-stage liver disease underwent A-A LDLT. Ten of these patients received dual grafts. The 157 men and 25 women had an age range of 18 to 68 years (mean age, 42 years). Microsurgical techniques and running sutures with back-wall first techniques were performed in all arterial reconstructions under surgical loupes (3.5 ×) by a group of vascular surgeons. Intimal dissections were resolved by interposition of the great saphenous vein (GSV) between the donor right hepatic artery (RHA) and recipient common HA (3 cases) or abdominal aorta (AA) (2 cases), by interposition of cryopreserved iliac vessels between the donor RHA and recipient AA (2 cases).

RESULTS: In the 58 incipient patients in this series, hepatic arterial thrombosis (HAT) was encountered in 4 patients, and was not observed in 124 consecutive cases (total 192 grafts, major incidence, 2.08%). All cases of HAT were suspected by routine color Doppler ultrasonographic examination and confirmed by contrast-enhanced ultrasound and hepatic angiography. Of these cases of HAT, two occurred on the 1st and 7th d, respectively, following A-A LDLT, and were immediately revascularized with GSV between the graft and recipient AA. HAT in one patient occurred on the 46th postoperative day with no symptoms, and the remaining case of HAT occurred on the 3rd d following A-A LDLT, and was cured by thrombolytic therapy combined with an anticoagulant but died of multiorgan failure on the 36th d after A-A LDLT. No deaths were related to HAT.

CONCLUSION: Applying microsurgical techniques and selecting an appropriate anastomotic artery for HA reconstruction are crucial in reducing the high risk of HAT during A-A LDLT.

Keywords: Adult-to-adult living donor liver transplantation; Hepatic arterial thrombosis; Microsurgical reconstruction