Outcome of pediatric liver transplant in grafts with multiple arteries

Young age, small diameter of the hepatic artery, presence of multiple arteries, and the selected technique are risk factors for hepatic arterial complications. We report the outcomes of pediatric liver transplant (LT) patients who had received a liver graft with multiple arteries. Since April 2001, 89 pediatric LTs have been performed at our center. Twenty-six liver grafts (29.2%) that had multiple hepatic arteries were analyzed retrospectively. Twenty-five grafts had 2, and 1 graft had 3, hepatic arteries. In 17 grafts with double arteries, and in 1 graft with 3 arteries, the adjacent edges of the hepatic arteries were sutured together at the back table to create a single opening, and the recipient's common hepatic artery was then anastomosed to that orifice. In 8 grafts with double arteries, 2 separate anastomoses were performed between the graft hepatic arteries and the recipient's hepatic artery branches. The mean age of the recipients was 7.9 +/- 5.4 years (range, 0.6-17 years). During the early postoperative period, hepatic arterial thromboses occurred in 3 recipients. Two of these 3 recipients were treated with transcatheter arterial thrombolysis using streptokinase or recombinant plasminogen and intraluminal stent placement, and the remaining recipient was treated with a re-anastomosis using a polytetrafluoroethylene graft. Three recipients died during follow-up, which ranged from 1 to 71 months. In conclusion, multiple graft arteries did not increase the incidence of hepatic arterial complications in our series.