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. 2019 Feb;8(1):10-18.
doi: 10.21037/hbsn.2018.11.13.

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Tsan-Shiun Lin  1 , Nelamangala Ramakrishnaiah Vishnu Prasad  1 , Chao-Long Chen  1 , Johnson Chia-Shen Yang  1 , Yuan-Cheng Chiang  1 , Pao-Jen Kuo  1 , Chih-Chi Wang  1 , Shih-Ho Wang  1 , Yueh-Wei Liu  1 , Chee-Chien Yong  1 , Yu-Fan Cheng  1
Affiliations

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Tsan-Shiun Lin et al. Hepatobiliary Surg Nutr. 2019 Feb.

Abstract

Background: The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up.

Methods: From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope.

Results: In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1-1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate re-do anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis.

Conclusions: Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to re-do the HAR immediately.

Keywords: Hepatic artery (HA); liver transplantation (LT); microvascular surgery; reconstruction; thrombosis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Bar chart showing the number of problematic cases. HAR, hepatic artery reconstruction; GEA, gastro epiploic artery.
See this image and copyright information in PMC

Comment in

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