Management of vascular complications after living donor liver transplantation

Vascular complications after liver transplantation remain a major source of morbidity and mortality for recipients especially those receiving LDLT owing to the complex vascular reconstruction.

During the period from May 1999 to May 2004, 518 LDLT were performed in the Department of Liver Transplantation and Immunology, Kyoto University Hospital, Japan.

The recipients were 261 males and 257 females. Pediatric cases were 230. The indications were cholestatic diseases in 42.5%, chronic hepatocellular diseases (CHD) in 13.3%, HCC in 18.5%, other tumors in 2.7% and others in 23%. Small for- size grafts in 4.8%, accepted size grafts in 16.0%, optimum size grafts in 74.5% and large-for-size grafts in 4.6%. Vascular complications occurred during hospital stay in 6.4%, within 3 months from discharge in 2.5% and after 3 months from discharge in 6.0%. The success rate of the management of HAT was 83.3%, portal vein complications was 97.6% and hepatic vein complications was 84.6%.

Careful preoperative evaluation and the proper intraoperative techniques in vascular reconstruction prevent vascular complications. Intraoperative microsurgical technique for hepatic artery reconstruction decreases hepatic artery complications. Routine post transplant Doppler examination should be performed at least twice a day for the first week after the operation. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated by balloon angioplasty and endoluminal stent to avoid late complications and even mortality.