Effects of Preservation of Donor Liver Gastroduodenal Artery on Post-Transplant Biliary Complications in 187 Liver Transplant Recipients: A Retrospective Study

Abstract

BACKGROUND This retrospective study aimed to evaluate the effects of preservation of the donor liver gastroduodenal artery on post-transplant biliary complications in 187 liver transplant recipients. MATERIAL AND METHODS The clinical data of 187 liver transplantation recipients were retrospectively analyzed. Recipients were divided into conventional and modified groups. The technical point of the modified group is to preserve at least 2 cm of the distal gastroduodenal artery, and pay special attention to preserve the superior pancreaticoduodenal artery to ensure the distal blood supply to the common bile duct. RESULTS The modified group had significantly shorter operative time (7.17 vs 7.98) h (P<0.001) and less intraoperative blood loss (2715.40 vs 3434.93) ml (P=0.003) than the conventional group. The incidence of postoperative biliary complications (including anastomotic biliary leakage, ischemic bile duct stenosis, and anastomotic bile duct stenosis) in the modified group (4/114, 4.1%) was significantly lower (15/73, 20.5%) (P<0.001). There was no significant difference in the intraoperative cold and warm ischemia time and postoperative hospital stay length between the 2 groups. In addition, there was no significant difference in the effect of cardiac-death and brain-death sources on perioperative biliary complications, while the peak postoperative transaminase and total bilirubin were higher in patients receiving the donor liver of cardiac death (P<0.05). CONCLUSIONS Preserving the integrity of the donor gastroduodenal artery and surrounding tissue is beneficial to protect the blood supply of the extrahepatic bile duct, and can reduce the incidence of biliary complications.

Figure 1

Common bile duct blood supply pattern diagram. The vascular network around the hilar bile originates mainly from the branches of the right hepatic artery and the gallbladder artery, and the bile vessel network below the common hepatic duct is more derived from the gastroduodenal artery and its branches including the anterior superior pancreaticoduodenal artery and posterior superior pancreaticoduodenal artery. CBD – common bile duct; GDA – gastroduodenal artery; PSPDA – posterior superior pancreaticoduodenal artery; ASPDA – anterior superior pancreaticoduodenal artery; SMA – superior mesenteric artery; IPDA – inferior pancreaticoduodenal artery; PIPDA – posterior inferior pancreaticoduodenal artery; AIPDA – anterior inferior pancreaticoduodenal artery.

Figure 2

Anatomical diagram of extrahepatic duct blood supply (anterior view). PHA – proper hepatic artery; CHA – common hepatic artery; RGA – right gastric artery; SA – splenic artery.

Figure 3

The anatomical diagram of extrahepatic duct blood supply (posterior view). The vascular network around the hilar bile originates mainly from the branches of the right hepatic artery and the gallbladder artery, and the bile vessel network below the common hepatic duct is more derived from the gastroduodenal artery and its branches including the posterior superior pancreaticoduodenal artery and the anterior superior pancreaticoduodenal artery. IVC – inferior vena cava; LRV – left renal vein; RRA – right renal artery.

Figure 4

The picture of intraoperative hilar region before bile duct anastomosis. The vessel of the forceps lift was the donor-derived pancreaticoduodenal artery (green circle). The blue arrow indicates the portal vein anastomosis and the red arrow indicates the arterial anastomosis.

Figure 5

The picture of intraoperative hilar region after bile duct anastomosis. The green circle indicates donor-derived pancreaticoduodenal artery, and the yellow allow indicates the bile duct anastomosis. The blue arrow indicates the portal vein anastomosis and the red arrow indicates the arterial anastomosis.