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Back-table arterial reconstructions in liver transplantation: single-center experience
1Istituto di Chirurgia Sperimentale, dei Trapianti e Cardiovascolare, Università degli Studi di Milano, Unità Operativa Complessa, Centro Trapianto di Fegato e Polmone, Ospedale Maggiore IRCCS, Milano, Italy.
Transplantation Proceedings
|September 27, 2005
Summary
Hepatic artery variations (HAV) in liver grafts occur in 21.4% of cases, often requiring complex reconstructions. While reconstructions slightly increase thrombosis risk, survival rates remain comparable to grafts without variations.
Area of Science:
- Transplantation Surgery
- Vascular Anatomy
- Graft Survival
Background:
- Anatomic variations in donor liver graft arterial supply necessitate complex hepatic artery reconstructions.
- These reconstructions increase the risk of arterial thrombosis and graft loss due to additional anastomoses.
Purpose of the Study:
- To review the incidence and types of hepatic artery variations (HAV) in liver grafts.
- To analyze the types of hepatic artery reconstructions performed.
- To evaluate the impact of HAV and reconstructions on graft and patient survival rates after orthotopic liver transplantation (OLT).
Main Methods:
- Retrospective review of 620 orthotopic liver transplantations (OLT) from June 1983 to August 2004.
- Analysis of donor hepatic artery variations (HAV) and surgical reconstruction techniques.
- Assessment of 1- and 5-year graft and patient survival rates.
Main Results:
- Hepatic artery variations (HAV) were present in 133 liver grafts (21.4%).
- The most common variation was the right hepatic artery (RHA) originating from the superior mesenteric artery (SMA).
- Of 133 grafts with HAV, 56 (42%) required arterial reconstruction, with termino-terminal (TT) anastomosis between RHA and splenic artery being most frequent.
- Hepatic artery thrombosis occurred in 5.4% of complex reconstructions versus 2.2% in other grafts.
- One- and 5-year survival rates were 73.2%/71.4% with reconstructions and 78.6%/76.8% without.
Conclusions:
- Hepatic artery variations are common in liver grafts and often require surgical reconstruction.
- While complex reconstructions are associated with a slightly higher rate of hepatic artery thrombosis, they do not significantly compromise long-term graft or patient survival.
- Careful surgical planning and execution of reconstructions are crucial for successful liver transplantation in the presence of arterial variations.