Modified technique for aortic cross-clamping during liver donor procurement.

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.