Alternative methods of arterialization of the hepatic graft

Abstract

During the course of performing 123 consecutive orthotopic liver transplantations in a two year period, a total of 220 livers were encountered (123 donors and 97 recipient organs), 24 of which had inadequacies or anomalies of hepatic arterial supply which required modifications of the basic techniques of arterial reconstruction. The various methods used to deal with these various situations are described herein. The use of vessel grafts from the donor has proved quite satisfactory over a number of years. The routine procurement of various vessel grafts can provide a multiplicity of options for arterial reconstruction, only a few of which have been mentioned herein.

Fig. 1

Use of iliac arterial graft between recipient aorta and homograft celiac axis.

Fig. 2

Use of incontinuity aortic graft for anastomosis to recipient aorta.

Fig. 3

Reconstruction which can be used if the hepatic arterial supply comes from both the celiac axis and superior mesenteric artery. a and b, These versions differ only in that the opposite ends of the superior mesenteric artery are used for the anastomosis to the recipient vessels.

Fig. 4

Hepatic arteriogram of a liver reconstructed by the technique shown in Figure 3a. The arrows show the two anastomoses.

Fig. 5

The use of an incontinuity donor aortic graft in a patient with a double hepatic arterial supply.