Document Detail

Extra-anatomical hepatic artery reconstruction in living donor liver transplantation: can this procedure save hepatic grafts?
MedLine Citation:
PMID:  20818743     Owner:  NLM     Status:  MEDLINE    
Graft hepatic arteries (HAs) are usually reconstructed with a recipient HA branch (anatomical HA reconstruction) in living donor liver transplantation (LDLT). Surgeons often encounter difficulties in reconstructing HAs, particularly when a recipient artery other than an HA branch must be used; this is known as extra-anatomical HA reconstruction. The outcomes of LDLT recipients with extra-anatomical HA reconstruction were retrospectively reviewed. Between October 1996 and October 2009, we performed primary LDLT 335 times, re-LDLT 8 times, and HA re-reconstruction 5 times for patients with HA complications. Thirty-three extra-anatomical HA reconstructions were performed in 22 patients with primary LDLT (6.6%), 4 patients with re-LDLT (50%), and 4 patients with HA re-reconstructions for HA complications (80%). In extra-anatomical HA reconstructions, we used 12 right gastroepiploic arteries, 6 right gastric arteries, 5 gastroduodenal arteries, 2 left gastric arteries, 2 splenic arteries, 2 cystic arteries, and 4 interposition grafts as recipient inflow arteries. Only 1 HA-related complication, the formation of an aneurysm, occurred after extra-anatomical HA reconstruction. The overall graft and patient survival probabilities after primary LDLT with extra-anatomical HA reconstruction were comparable to those after LDLT with anatomical HA reconstruction, although approximately half of the patients with extra-anatomical HA reconstruction suffered anastomotic biliary strictures. Therefore, extra-anatomical HA reconstruction can be safely performed through the proper selection of recipient arteries and the use of interposition grafts. These procedures can save hepatic grafts, even when recipient HAs cannot be used as inflow arteries.
Hideaki Uchiyama; Ken Shirabe; Akinobu Taketomi; Yuji Soejima; Mizuki Ninomiya; Hiroto Kayashima; Toru Ikegami; Yoshihiko Maehara
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  16     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-06     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1054-61     Citation Subset:  IM    
Copyright Information:
(c) 2010 AASLD.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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MeSH Terms
Anastomosis, Surgical
Child, Preschool
Gastroepiploic Artery / surgery
Graft Survival*
Hepatic Artery / surgery*
Kaplan-Meier Estimate
Liver Transplantation* / adverse effects,  mortality
Living Donors*
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Splenic Artery / surgery
Time Factors
Treatment Outcome
Vascular Surgical Procedures / adverse effects,  mortality
Young Adult

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