Arterial anastomosis in LDLT: techniques and risks

Reconstructing the hepatic artery in adult living donor liver transplantation is technically challenging, with complications leading to significant morbidity and mortality. Early arterial thrombosis can result in a mortality rate up to 50%, often necessitating re-transplantation. The most common techniques for arterial anastomosis include end-to-end reconstruction with interrupted or continuous sutures, either using magnifying loupes or a microscope. Although microscopes provide enhanced precision, they do not significantly reduce early thrombosis rates compared to loupes but increase surgical time. Overall, surgeons can achieve early thrombosis rates below 1% with experience and evolving techniques.