Minimizing Hepatic Artery Thrombosis and Establishing Safety of Grafts With Dual Arteries in Living Donor Liver Transplantation

• Published in: Transplantation proceedings Vol. 50; no. 5; pp. 1378 - 1385
• Main Authors: Mehta, N.N., Mangla, V., Varma, V., Lalwani, S., Mehrotra, S., Chawla, D., Nundy, S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2018
• Subjects: Adolescent; Adult; Aged; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Child; Child, Preschool; Female; Hepatic Artery - surgery; Humans; Infant; Liver Transplantation - adverse effects; Liver Transplantation - methods; Living Donors; Male; Middle Aged; Retrospective Studies; Thrombosis - etiology; Thrombosis - prevention & control; Treatment Outcome; Vascular Surgical Procedures - methods; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.02.065

Hepatic artery thrombosis (HAT) is a dreaded complication following living donor liver transplantation (LDLT) and can lead to graft failure and biliary complications. We evaluated the results of our arterial anastomotic technique and outcomes in grafts with dual arterial supply. Between July 2010 and June 2015, 225 patients underwent LDLT. The hepatic artery anastomosis was done using our “W technique”. In grafts with a dual arterial supply, two anastomoses were performed unless there was significant pulsatile back-bleeding in the smaller artery after the larger anastomosis. The mean age of the recipients was 43±15.2 years (6 months to 66 years). There were 184 right liver, 30 left liver, 10 left lateral segment, and 1 dual lobe (right liver and left lateral segment) grafts. Twenty-three (10.2%) patients had 2 graft arteries, 10 of which required 2 separate anastomoses, and an interposition saphenous vein conduit was used in one. HAT occurred in 3 (1.3%) patients. The median intensive care unit and postoperative hospital stays were 5 and 14 days, respectively. Post-transplant operative mortality was 12.4%. There was no difference in mortality (8.7% vs 12.4%, P = >.99) and biliary complications (11.9% vs 21.7%, P = .19) between recipients of grafts with single or dual graft arteries, respectively. A careful surgical “W technique” and intraoperative confirmation of a good arterial flow helps in reducing the incidence of early HAT. The presence of two arteries in the graft was not associated with increased incidence of HAT, mortality, or biliary complications. •Prospective study.•“W technique” of hepatic arterial anastomosis resulting in low incidence of HAT in LDLT.•No impact of presence of two graft arteries on incidence of HAT or mortality.•Partial reconstruction in grafts with dual arterial supply, associated with higher (but not statistically significant) biliary complications.