Use of recipient's left hepatic artery for artery reconstruction in right lobe living donor liver transplantation with duct-to-duct anastomosis

Abstract

Background: The hepatic arteries (HAs) in a hepatic graft are usually reconstructed using the recipient's left or right HAs in living donor liver transplantation (LDLT). There have been no apparent selection criteria concerning which of the recipient's HAs should be used. This study retrospectively investigated whether the selection of left or right HA for HA reconstruction affects the outcomes of right lobe LDLT (RL-LDLT).

Methods: Ninety-nine RL-LDLT were performed between July 1998 and March 2009. After excluding 10 cases of RL-LDLT with complex HA reconstruction(s), 89 cases of RL-LDLT were divided into four groups: RL-LDLT with duct-to-duct biliary anastomosis with an HA reconstruction using the recipient's left HA (DD-L-group; n=41), the recipient's right HA (DD-R-group; n=27), RL-LDLT with hepaticojejunostomy with an HA reconstruction using the recipient's left HA (HJ-L-group; n=11), and the recipient's right HA (HJ-R-group; n=10). The outcomes of RL-LDLT were compared among these four groups.

Results: Septic complications occurred more frequently in the DD-R-group than in the DD-L-group (2.4% vs. 22.2%, P=0.013). Furthermore, 39% of the patients in the DD-R-group suffered anastomotic biliary stricture within 2 years after transplantation, in comparison with 8.1% in the DD-L-group (P=0.003). The selection of the recipient's left or right HA did not influence patient outcomes in the case of a hepaticojejunostomy.

Conclusions: The DD-L-group patients experienced favorable outcomes in comparison with the DD-R-group patients. Therefore, recipient's left HAs should be selected for HA reconstruction in RL-LDLT when biliary reconstruction is performed by duct-to-duct anastomosis.