Introduction: Hepatic artery (HA) reconstruction is one of the most crucial procedures when performing living donor liver transplantation (LDLT), especially in pediatric patients. Hepatic artery thrombosis (HAT) is the most feared complications of all as it can result in early graft loss and mortality. The liver grafts can at times have multiple hepatic arterial branches (HA). The size discrepancy between graft and recipient along with presence of multiple HAs in graft makes HA reconstruction even more challenging. Hence, discrete decision of reconstructing one or both the hepatic arteries is required. We herein report the criteria for reconstructing single or dual HAs and its outcome in pediatric LDLT.

Material and Methods: From 2002 to 2010, 101 of 103 pediatric patients undergoing LDLT received a left of left lateral segment liver grafts. The study population of was divided in to Group 1 (n= 21): 2 HA stumps with 2 HAs reconstruction, Group 2 (n=22): 2 HA stumps with 1 HA reconstruction and Group 3 (n=60): 1 HA stump with 1 HA reconstruction. The criteria for reconstruction of only one the two HAs were, that the selected artery was a dominant one on pre-operative radiological assessment, it was thicker of the two arteries on intra-operative assessment, good blood backflow was observed intra-operatively, from the remaining arterial stump post reconstruction of dominant one and intra-operative arterial Doppler confirmed arterial inflow signals in all segments of the liver graft post reconstruction of the dominant artery. If any of these criteria were not met, dual HA reconstruction was done. The incidence of hepatic artery related complications, biliary complications and patient survival were analyzed between the three groups.

Results: The operative time in Group 1was more as compared to Groups 2 and 3 (p=0.01). The incidence of hepatic arterial related complications and biliary complications were similar in all the 3 groups, p=0.91 and p=0.24 respectively.

Conclusions: In accordance with the aforementioned criteria, we recommended to reconstruct only single HA in pediatric patients undergoing LDLT, with 2 arterial stumps. This makes the reconstruction much less technically demanding with comparable outcome.