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Updated: May 1, 2026
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Modified technique for aortic cross-clamping during liver donor procurement
Chirag S Desai1, Raffaele Girlanda, Jason Hawksworth
1Medstar Georgetown Transplant Institute, Washington, DC, USA.
Insights
A novel surgical approach to the supraceliac aorta during liver procurement minimizes vascular damage, especially in pediatric and obese donors. This technique enhances donor organ safety and reduces graft loss from hepatic artery thrombosis.
Area of Science:
- Surgical Techniques
- Organ Procurement
- Vascular Surgery
Background:
- Vascular damage during organ procurement, particularly to the hepatic artery (HA), can lead to graft loss.
- Conventional dissection for supraceliac aorta exposure poses risks, especially in pediatric and obese donors with delicate or small anatomical spaces.
- Replaced or accessory left hepatic arteries (R/A LHA) are particularly vulnerable to damage with standard techniques.
Purpose of the Study:
- To describe a modified surgical technique for exposing the supraceliac aorta during liver procurement.
- To enhance the safety and ease of organ procurement, particularly for challenging donor types.
- To reduce the incidence of vascular injury and subsequent graft loss.
Main Methods:
- A modified approach to the supraceliac aorta from the left side, behind the gastroesophageal junction, avoiding division of the gastrohepatic ligament.
- Application of this technique in 104 liver procurements between May 2007 and May 2013.
- Inclusion of adult and pediatric donors, with specific attention to those with R/A LHA.
Main Results:
- No donor organs sustained damage during procurement using the modified technique.
- The technique was applied to 104 liver procurements, including 15 pediatric donors and 23 donors with R/A LHA.
- One adult recipient experienced HA thrombosis, unrelated to the procurement technique.
Conclusions:
- The described technical modification improves the safety of cadaveric liver procurement.
- This approach facilitates easier and safer exposure of the supraceliac aorta, reducing the risk of vascular injury.
- The technique is particularly beneficial for pediatric and obese donors, as well as those with anatomical variations like R/A LHA.
Abstract:
Undue tension on the donor vessels during organ procurement is associated with intimal dissection, which can form the nidus for the thrombosis of the hepatic artery (HA) and graft loss. According to the US OPTN database, 143 grafts were discarded in the last 15 yr due to vascular damage during procurement. The most common technique to expose the supraceliac aorta is dissection between the left lateral segment of the liver and the esophagus-stomach. In obese donors, due to restricted space and in pediatric donors where the vessels are very delicate and this space is very small, the replaced or accessory left HA(R/A LHA) is prone to damage if approached conventionally. We describe a technique for the exposure of the supraceliac aorta in which the aorta is approached from the left side behind the gastroesophageal junction that does not require division of the gastrohepatic ligament. From May 2007 to May 2013, 104 liver procurements were performed. Eighty-nine (85.6%) were adults, and 15 (14.4%) were pediatric donors. Twenty-three (22.1%) had R/A LHA. No donor organ suffered any damage. One adult recipient with R/A LHA suffered HA thrombosis not related to it. In summary, this technical modification offers improved safety during cadaveric procurement and increases the ease.
