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Hepatic artery-related complications after live donor liver transplantation

Viniyendra Pamecha1, Piyush Kumar Sinha2, Amar Mukund3

  • 1Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India. viniyendra@yahoo.co.uk.

Langenbeck'S Archives of Surgery
|January 13, 2023
PubMed

Insights

Hepatic artery-related complications (HARC) after live donor liver transplantation (LDLT) are manageable with early detection and revascularization, leading to outcomes similar to patients without complications. Technical improvements, like the clockwise technique, can reduce the risk of hepatic artery thrombosis (HAT).

Area of Science:

  • Hepatology
  • Transplant Surgery
  • Vascular Surgery

Background:

  • Hepatic artery-related complications (HARC) following live donor liver transplantation (LDLT) are linked to significant morbidity and mortality.
  • Early identification and intervention are crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze the etiology, detection, management, and outcomes of HARC in LDLT recipients.
  • To identify factors influencing HARC development and outcomes.

Main Methods:

  • Prospective data analysis of 657 LDLT procedures performed between July 2011 and September 2020.
  • Detailed review of HARC cases, including hepatic artery thrombosis (HAT) and non-thrombotic hepatic artery complications (NTHAC).
  • Evaluation of surgical and endovascular interventions, and systemic anticoagulation strategies.

Main Results:

  • HARC occurred in 3.2% of patients (21/657), with HAT in 2.4% (16/657) and NTHAC in 0.76% (5/657).
  • Ninety percent of HARC were asymptomatic and detected via protocol Doppler, with a median detection time of 4 days.
  • Successful revascularization was achieved in 81% of HAT cases; overall mortality was 14.8%.
  • The clockwise technique for arterial reconstruction was associated with a decreased risk of HAT (p=0.003).

Conclusions:

  • Technical refinements, early detection, and timely revascularization are key to achieving favorable outcomes in HARC patients post-LDLT.
  • While survival rates are comparable to those without HARC, biliary complications remain a concern.
  • The clockwise arterial reconstruction technique shows promise in reducing HAT incidence.
Abstract

Keywords:
Endovascular interventionHepatic artery related complicationsLive donor liver transplantSurgical revascularization

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