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Updated: Mar 17, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with
Yukihiro Sanada1, Shuji Hishikawa2, Noriki Okada3
1Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan. yuki371@jichi.ac.jp.
Insights
Monosegmental living donor liver transplantation (LDLT) in infants has high rates of hepatic artery complications (HACs). However, hepatic artery reconstruction is feasible using the branch patch technique and dorsal approach, despite external factors causing HACs.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Surgery
Background:
- Living donor liver transplantation (LDLT) in infants often involves small graft sizes.
- Hepatic artery complications (HACs) are a significant concern in pediatric LDLT.
- Monosegmental grafts present unique challenges in hepatic artery reconstruction.
Purpose of the Study:
- To analyze the surgical procedure for hepatic arterial reconstruction in monosegmental LDLT for infants.
- To evaluate the outcomes and incidence of HACs in monosegmental LDLT.
- To identify key techniques for successful hepatic artery reconstruction in this population.
Main Methods:
- Retrospective analysis of 13 monosegmental LDLT cases out of 275 total LDLT procedures (May 2001-December 2015).
- Microscopic hepatic artery reconstruction.
- Definition of graft to recipient distance ratio (GRDR) using preoperative CT scans.
- Definition of HACs as hepatic arterial hypoperfusion.
Main Results:
- The branch patch technique was used in 38.5% of cases.
- Dorsal versus ventral portal vein (PV) approaches were associated with different GRDRs (2.8 ± 0.4 vs. 1.9 ± 0.5, p=0.012).
- HACs due to external factors were significantly higher in monosegmental recipients (15.4%) compared to non-monosegmental (1.1%, p<0.001).
Conclusions:
- Hepatic artery reconstruction in monosegmental LDLT is achievable.
- The branch patch technique and dorsal approach are crucial for successful reconstruction.
- External factors around the anastomotic site contribute to HACs in monosegmental LDLT recipients.
Purpose:
When living donor liver transplantation (LDLT) is performed on small infant patients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT.
Methods:
Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient's abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion.
Results:
Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 ± 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 ± 0.4 and 1.9 ± 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001).
Conclusion:
Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.
