Hepatic Artery Reconstruction in Living Donor Liver Transplantation: Running Suture Under Surgical Loupes by Cardiovascular Surgeons in 180 Recipients

• DOI: 10.1016/j.transproceed.2012.01.059
• Publication Date: 2012-03-10T17:14:23Z
• Authors: P.-C. Li; L.-B. Jeng; H.-R. Yang; C.-C. Lee; K.-S. Poon; T.-H. Chen; C.-C. Yeh; H.-C. Lai; W.-P. Su; C.Y. Peng; Y.-F. Chen; Y.-J. Ho
• Keywords: Hepatolithiasis

The aim of our study was to retrospectively investigate the outcomes of hepatic artery (HA) reconstruction by cardiovascular surgeons in adult-to-adult living donor liver transplantation (A-A LDLT).From April 2007 to April 2011, 187 recipients underwent A-A LDLT. After excluding seven ABO-incompatible transplant recipients, we reviewed the courses of 180 patients including 125 men and 55 women of mean age 52.5±9.2 years (range=23-71). One hundred seventy-seven patients received right-lobe grafts with inclusion of middle hepatic vein (MHV); two, right-lobe grafts without MHV; and one, left-lobe graft. A continuous, single-stitch, running suture with the parachute technique was used for HA reconstruction. The anastomosis was performed by cardiovascular surgeons employing surgical loupes with 4.5× magnification.The mean time for an arterial reconstruction was 10.7±4.0 minutes (median=10, range=4-30). Hepatic arterial thrombosis (HAT) was encountered in 3 (1.66%) patients. One HAT that developed on postoperative day 1 was successfully rescued by the intra-arterial infusion of urokinase. Another patient required reoperation due to a redundant kinked HA. A third HAT patient underwent successful retransplantation with a cadaveric graft on postoperative day 6. In our series, no delayed HAT was detected and no recipient deaths were related to HAT.HA reconstruction with a running suture under surgical loupes is a feasible technique in A-A LDLT. A speedy reconstruction can be performed by an experienced cardiovascular surgeon with a low incidence of HAT.