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Review
. 2025 Oct;77(6):1859-1860.
doi: 10.1007/s13304-024-01983-4. Epub 2024 Sep 26.

Arterial anastomosis in LDLT: techniques and risks

Stefano Di Sandro  1   2 , Barbara Catellani  3 , Deniz Balci  4 , Fabrizio Di Benedetto  5   6 ; Micro-Surgical Study Group
Affiliations
Review

Arterial anastomosis in LDLT: techniques and risks

Stefano Di Sandro et al. Updates Surg. 2025 Oct.

Abstract

Reconstructing the hepatic artery in adult living donor liver transplantation is technically challenging, with complications leading to significant morbidity and mortality. Early arterial thrombosis can result in a mortality rate up to 50%, often necessitating re-transplantation. The most common techniques for arterial anastomosis include end-to-end reconstruction with interrupted or continuous sutures, either using magnifying loupes or a microscope. Although microscopes provide enhanced precision, they do not significantly reduce early thrombosis rates compared to loupes but increase surgical time. Overall, surgeons can achieve early thrombosis rates below 1% with experience and evolving techniques.

Keywords: Living donor liver transplantation; arterial anastomosis; interrupted stiches; loupes; microscope; running suture.

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Conflict of interest statement

Declarations. Conflicts of interest: Authors have no conflict of intereset to discolse. Ethical approval: Not required. Research involving human participants and/or animals: Not applicable. Informed consent: For this type of study, formal consent is not required.

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