Back Table Arterial Reconstructions Using the Recipient Hepatic Arterial Tree in Living Donor Liver Transplantation.

Area of Science:

• Hepatobiliary Surgery
• Transplantation Surgery
• Vascular Reconstruction

Background:

• Complex arterial anatomy in liver grafts often necessitates reconstruction.
• Reconstruction on the back table offers optimal surgical conditions.
• Utilizing the recipient's hepatic arterial system provides size-matched branches.

Purpose of the Study:

• To evaluate the efficacy of back table arterial reconstruction using the recipient's hepatic arterial tree in living donor liver transplantation (LDLT).
• To assess the outcomes and complications associated with this technique.

Main Methods:

• Back table reconstruction using recipient hepatic arteries was performed in 29 out of 379 LDLT patients (7.7%) between 2001 and 2022.
• Reconstructed arterial trees were anastomosed in situ to the recipient's arterial system.
• This method was employed when arterialized back-bleeding was not present.

Main Results:

• Cold ischemia times were longer in the back table reconstruction group compared to controls.
• Hepatic artery thrombosis (HAT) occurred in two patients, one requiring re-transplantation, but overall HAT rates did not differ significantly from other LDLT patients.
• One- and 5-year patient survival rates were 89.6% and 82.6%, respectively.

Conclusions:

• Back table reconstruction utilizing the recipient hepatic arterial tree is a feasible and successful strategy for managing complex arterial anatomy in LDLT.
• This technique provides a valuable alternative when arterialized back-bleeding is insufficient.