Versatility of Right Gastroepiploic and Gastroduodenal Arteries for Arterial Reconstruction in Adult Living Donor Liver Transplantation

• Published in: Transplantation proceedings Vol. 43; no. 5; pp. 1716 - 1719
• Main Authors: Lee, J.H., Oh, D.Y., Seo, J.W., Moon, S.H., Rhie, J.W., Ahn, S.T.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.06.2011; Elsevier
• Subjects: Adult; Arteries - surgery; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Middle Aged; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Tomography, X-Ray Computed; Vascular Surgical Procedures; Human; Right gastroepiploïc artery; Digestive system; Living donor; Liver; Anatomical reconstruction; Homotransplantation; Medicine; Gastroduodenal; Treatment; Surgery; Adult; Graft; Liver transplantation
• ISSN: 0041-1345; 1873-2623; 1873-2623
• DOI: 10.1016/j.transproceed.2011.03.030

In cases where there is severe intimal dissection in the recipient hepatic artery (HA), or if the HA has been used already and additional operations are needed due to graft rejection or arterial occlusion, an alternative is necessary. In the present study, we have reported the feasibility of using the right gastroepiploic artery (RGEA) and gastroduodenal artery (GDA) in various situations where the HA is not a feasible option. Among 463 patients who underwent primary adult-to-adult living donor liver transplantation from January 2002 to July 2010, eight subjects required alternative vessels. Four recipients displayed severe intimal injury associated with previous transarterial chemoembolization (TACE); two, required a salvage operation due to hepatic artery thrombosis (HAT); and two, retransplantations due to chronic rejection. The RGEA was used in five and the GDA in three patients. Postoperative Doppler ultrasonography and three-dimensional computed tomography showed patent arterial flow in all patients. However, HAT recurred in one patient who underwent a salvage operation with the RGEA; she died 2 months later. Two other patients died due to wound infection and respiratory failure within 3 months despite intact hepatic arterial flow. Four patients had no further complications during follow-up (mean = 33 months). Although there was a discrepancy in the diameter of the HA and the RGEA (or GDA), there was no problem with mobilization and microanastomosis. We therefore believe that these vessels can be good alternatives when the hepatic artery is unavailable.