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Donor arterial variations in liver transplantation: management and outcome of 527 consecutive grafts
A S Soin1, P J Friend, A Rasmussen
1University of Cambridge Clinical School, Transplant Unit, UK.
Insights
Donor arterial variations in liver transplants occur in one-third of cases. These variations do not impact graft outcomes unless complex arterial reconstruction is needed.
Area of Science:
- Transplantation Surgery
- Vascular Anatomy
- Graft Outcomes
Background:
- Hepatic arterial anomalies are common, affecting approximately one-third of liver allografts.
- The clinical significance of these arterial variations on graft survival and complications remains a subject of investigation.
Purpose of the Study:
- To retrospectively analyze the impact of donor arterial variations on the outcomes of liver allografts.
- To identify specific surgical scenarios where arterial anomalies may compromise graft function or lead to complications.
Main Methods:
- Retrospective review of 527 consecutive liver allografts.
- Analysis of arterial anatomy variations and their correlation with arterial and biliary complications.
- Comparison of outcomes between grafts with normal and anomalous arterial supply.
Main Results:
- Anomalous arteries were identified in 30.6% of allografts.
- No significant difference in overall arterial complications between normal (3.6%) and anomalous (5.6%) arterial anatomy.
- Increased arterial complications were observed in transplants requiring multiple arterial anastomoses or direct anastomosis to the recipient aorta.
- Biliary complication rates were similar for grafts with normal and anomalous arterial supply.
Conclusions:
- Hepatic arterial anomalies are frequent and generally do not compromise liver allograft outcomes.
- Complex arterial reconstruction techniques, such as multiple anastomoses or direct aortic anastomosis, are associated with a higher incidence of arterial complications in the presence of anomalous arteries.
- Careful surgical planning and execution are crucial for managing arterial variations to ensure successful liver transplantation.
Abstract:
The impact of donor arterial variations and their management was investigated retrospectively in 527 consecutive allografts. Anomalous arteries were found in 161 grafts (30.6 per cent). There was no significant difference in the overall incidence of arterial complications between grafts with normal (3.6 per cent) and abnormal (5.6 per cent) anatomy. However, there was a higher incidence of arterial complications in transplants requiring multiple arterial anastomoses (P = 0.02), or anastomosis of donor vessels to recipient aorta with (P = 0.0003) or without (P = 0.04) an interposition graft for arterial reconstruction. The incidence of biliary complications was similar in grafts with a normal (18.8 per cent) or anomalous (18.0 per cent) arterial supply. Anomalies of hepatic arterial anatomy occur in one-third of all livers and do not compromise graft outcome unless multiple anastomoses or direct anastomosis to the recipient aorta are required for arterial reconstruction.