J Korean Soc Transplant.  2010 Dec;24(4):284-288.

Experience with Microsurgical Reconstruction of the Hepatic Artery in 100 Living Donor Liver Transplantation

Affiliations
  • 1Department of Surgery, Catholic University of Daegu School of Medicine, Deagu, Korea. hyskhk@cu.ac.kr

Abstract

BACKGROUND
In living-donor-liver transplantation, microsurgical reconstruction of the hepatic artery is essential and this is challenging issue because of the small diameter of the vessels in the partial liver graft. We present our experiences for hepatic arterial reconstruction with focusing on the technical aspects.
METHODS
Methods: From May 2005 through December 2009, 100 patients received right hemiliver grafts (n=86) or left hemiliver grafts (n=14). Hepatic artery anastomosis was performed using microsurgical techniques. All the anastomoses were successfully accomplished by a single transplantation surgeon who worked under a microscope. Our classical method for arterial reconstruction in living donor liver transplantation (LDLT) consists of the interrupted end-to-end anastomosis between the hepatic artery of the graft and the most accessible hepatic artery of the recipient.
RESULTS
We could confirm the patency of the reconstructed artery during the early post-transplantation period. Ninety five patients had the hepatic arteries reconstructed by the conventional twist technique. We used the right gastroepiploic artery in one patient because of the intimal dissection of the hepatic artery, and we used an interposition graft, with using the greater saphenous vein, in 2 patients. technical complication was occurred in only 1 patient. The hepatic artery pseudoaneurysm was confirmed at 4 weeks after transplantation. Arterial steal syndrome was detected in 2 patients and this was treated by angiographic techniques.
CONCLUSIONS
Meticulous intraoperative microsurgical techniques and careful postoperative evaluation are very important in the hepatic artery reconstruction of LDLT. An experienced transplantation microscopy surgeon is also needed for creating safe anastomosis and achieving a lower complication rate.

Keyword

Living donors; Liver transplantation; Hepatic artery; Thrombosis; Microsurgery; Reconstructive surgical procedures

MeSH Terms

Aneurysm, False
Arteries
Gastroepiploic Artery
Hepatic Artery
Humans
Liver
Liver Transplantation
Living Donors
Microscopy
Microsurgery
Reconstructive Surgical Procedures
Saphenous Vein
Thrombosis
Transplants

Figure

  • Fig. 1. Interposition graft. Interposition graft using greater saphenous vein between graft hepatic artery and common hepatic artery.

  • Fig. 2. Pseudoaneurysm of hepatic artery anastomosis site. (A) CT finding. (B) Angiographic finding.


Reference

References

1). Ikegami T, Hashikura Y, Nakazawa Y, Urata K, Mita A, Ohno Y, et al. Risk factors contributing to hepatic artery thrombosis following living-donor liver transplantation. J Hepatobiliary Pancreat Surg. 2006; 13:105–9.
Article
2). Matsuda H, Yagi T, Sadamori H, Matsukawa H, Shinoura S, Murata H, et al. Complications of arterial reconstruction in living donor liver transplantation: a singlecenter experience. Surg Today. 2006; 36:245–51.
Article
3). Harashina T, Irigaray A. Expansion of smaller vessel diameter by fish-mouth incision in microvascular anastomosis with marked size discrepancy. Plast Reconstr Surg. 1980; 65:502–3.
Article
4). Testa G, Losanoff JE, Gangemi A, Benedetti E. Excellent outcome using an alternative technique for arterial reconstruction in living-related liver transplant: sphenoid anastomosis. Transpl Int. 2007; 20:392–4.
Article
5). Mori K, Nagata I, Yamagata S, Sasaki H, Nishizawa F, Takada Y, et al. The introduction of microvascular surgery to hepatic artery reconstruction in living-donor liver transplantation-its surgical advantages compared with conventional procedures. Transplantation. 1992; 54:263–8.
Article
6). Marcos A, Ham JM, Fisher RA, Olzinski AT, Posner MP. Surgical management of anatomical variations of the right lobe in living donor liver transplantation. Ann Surg. 2000; 231:824–31.
Article
7). Mazzaferro V, Esquivel CO, Makowka L, Belle S, Kahn D, Koneru B, et al. Hepatic artery thrombosis after pediatric liver transplantation-a medical or surgical event? Transplantation. 1989; 47:971–7.
8). Tzakis AG, Gordon RD, Shaw BW Jr, Iwatsuki S, Starzl TE. Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era. Transplantation. 1985; 40:667–71.
Article
9). Ulusal BG, Cheng MH, Ulusal AE, Lee WC, Wei FC. Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation. Microsurgery. 2006; 26:490–7.
Article
10). Xu W, Kim BW, Bae BK, Wang HJ, Kim MW. Effect of microsurgery training program for hepatic artery reconstruction in liver transplantation. Korean J Hepatobiliary Pancreat Surg. 2010; 14:25–9. .(허위광, 김봉완, 배병구, 왕희정, 김명욱. 간이식에 있어서 간동맥 재건을 위한 미세혈관수술교육의 효과: 미세수술교육부터 임상적용까지. 한국간담췌외과학회지 2010;14: 25–9.).
11). Yang Y, Yan LN, Zhao JC, Ma YK, Huang B, Li B, et al. Microsurgical reconstruction of hepatic artery in A-A LDLT: 124 consecutive cases without HAT. World J Gastroenterol. 2010; 16:2682–8.
Article
12). Itabashi Y, Hakamada K, Narumi S, Toyoki Y, Totsuka E, Umehara Y, et al. A case of living-related partial liver transplantation using the right gastroepiploic artery for hepatic artery reconstruction. Hepatogastroenterology. 2000; 47:512–3.
13). Tannuri U, Maksoud-Filho JG, Silva MM, Suzuki L, Santos MM, Gibelli NE, et al. An alternative method of arterial reconstruction in pediatric living donor liver transplantation with the recipient right gastroepiploic artery. Pediatr Transplant. 2006; 10:101–4.
Article
14). Someda H, Moriyasu F, Fujimoto M, Hamato N, Nabeshima M, Nishikawa K, et al. Vascular complications in living related liver transplantation detected with intraoperative and postoperative Doppler US. J Hepatol. 1995; 22:623–32.
Article
15). Kayahan Ulu EM, Coskun M, Ozbek O, Tutar NU, Ozturk A, Aytekin C, et al. Accuracy of multidetector computed tomographic angiography for detecting hepatic artery complications after liver transplantation. Transplant Proc. 2007; 39:3239–44.
Article
16). Kim SY, Kim KW, Kim MJ, Shin YM, Lee MG, Lee SG. Multidetector row CT of various hepatic artery complications after living donor liver transplantation. Abdom Imaging. 2007; 32:635–43.
Article
17). Chen HL, Concejero AM, Huang TL, Chen TY, Tsang LL, Wang CC, et al. Diagnosis and interventional radiological treatment of vascular and biliary complications after liver transplantation in children with biliary atresia. Transplant Proc. 2008; 40:2534–6.
Article
18). Lima CX, Mandil A, Ulhoa AC, Lima AS. Splenic artery steal syndrome after liver transplantation: an alternative technique of embolization. Transplant Proc. 2009; 41:1990–3.
Article
19). Sevmis S, Boyvat F, Aytekin C, Gorur SK, Karakayali H, Moray G, et al. Arterial steal syndrome after orthotopic liver transplantation. Transplant Proc. 2006; 38:3651–5.
Article
20). Shimizu K, Tashiro H, Fudaba Y, Itamoto T, Ohdan H, Fukuda S, et al. Splenic artery steal syndrome in living donor liver transplantation: a case report. Transplant Proc. 2007; 39:3519–22.
Article
Full Text Links
  • JKSTN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr