The arterial reconstructions required in living donor liver transplantation (LDLT) are technically difficult because of the small diameters of the vessels in the partial liver graft. In this study, we present our new hepatic arterial reconstruction technique. Between September 2001 and August 2008, we performed 190 LDLTs at our center. After December 2005, we changed our hepatic arterial reconstruction technique. Since then we’ve performed 114 LDLTs, 60 of which were pediatric recipients which were analyzed retrospectively. In this technique, native and graft hepatic arteries are spatulated from both the anterior and posterior walls for a wider anastomosis. Twenty-two of these recipients were infants and 28 of them weighed less than 10 kg. One of the recipients received a right lobe, 24 received a left lobe, and the remaining 35 received left lateral segment grafts. 85% of the donors were the recipient’s parents. Computed tomography (CT) angiography was used to evaluate both the vascular anatomy and the diameter of graft hepatic arteries. Hepatic arterial reconstruction was performed with microvascular technique using a surgical loop (2.5x) in all recipients by the same surgeon. Fifteen grafts had 2 hepatic arteries. In 11 grafts with double arteries, the adjacent edges of the hepatic arteries were sutured together to create a single opening, and the recipient common hepatic artery was then anastomosed to that orifice. In 4 grafts with double arteries, 2 separate anastomoses were performed between the graft hepatic arteries and the recipient hepatic artery branches. Mean diameter of the hepatic arteries was 2.3 ± 0.5 mm, and 26 of them were less than 2 mm. The 9 months (range, 1 to 32 months). Six of the 60 mean recipient follow-up was 16 recipients died and the remaining 54 (90%) are still alive with good graft functions. HAT was encountered in 2 (3.3%) recipients in this series. All of them were treated with interventional radiologic approaches. In conclusion, our new arterial reconstruction technique enabled the reconstruction of smaller arteries, multiple arteries and arteries with caliber differences even for the very small pediatric recipients.
Volume : 6
Issue : 4
Pages : 36
Department of General Surgery and Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey