Long-term outcome of hepatic artery reconstruction during living-donor liver transplantation.

Hepatic artery thrombosis (HAT) after living-donor liver transplantation (LDLT) is a potentially life-threatening complication. Although the introduction of microsurgical techniques has significantly decreased the incidence of HAT after LDLT, it remains a challenge for microsurgeons. We previously reported the use of the microsurgical hepatic arterial reconstruction technique during LDLT using the head-mounted surgical binocular system. In this study, we describe the long-term outcome of microsurgical hepatic artery reconstruction using the head-mounted surgical binocular system and our hepatic arterial reconstruction techniques on LDLT patients, including intimal dissection cases and clinical courses. Between August 2001 and February 2010, 146 patients underwent LDLT at our institution. Using a surgical loupe, the Varioscope AF3, which is a head-mounted surgical binocular system with automatic focusing and continuous zoom magnification from 3.6× to 7.2×, 150 arteries of 146 liver grafts were reconstructed. When the tunica intima was separated from the tunica media, suturing was performed from the inside of the vessels to the outside using an 8-0 monofilament Prolene with double needles, which facilitates secure sutures with good intima adaptation. The 1- and 3-year survival rates of the 146 patients were 80.3% and 74.9%, respectively, with a mean follow-up of 40.2 months. The mean diameter of the graft hepatic artery was 2.79 mm. HAT was not encountered in this series of patients. The use of the Varioscope and the application of our suturing techniques have provided entirely satisfactory long-term results of hepatic artery reconstruction during LDLT, even in intimal dissection cases.

Banshodani M ，Tashiro H ，Onoe T ，Ide K ，Ohdan H ... -  《-》

Microsurgical hepatic artery reconstruction during living-donor liver transplantation by using head-mounted surgical binocular system.

Ohdan H ，Tashiro H ，Ishiyama K ，Ide K ，Shishida M ，Irei T ，Ohira M ，Tahara H ，Itamoto T ，Asahara T ... -  《TRANSPLANT INTERNATIONAL》

[Hepatic arterial reconstruction and complications management in adult-to-adult living donor liver transplantation].

Zhao JC ，Yan LN ，Li B ，Ma YK ，Zeng Y ，Wen TF ，Wang WT ，Yang JY ，Xu MQ ，Chen ZY ... -  《-》

[Reconstruction of hepatic artery in adult to adult living donor liver transplantation in 104 patients].

Zhao JC ，Yan LN ，Li B ，Ma YK ，Zeng Y ，Wen TF ，Wang WT ，Yang JY ，Xu MQ ，Chen ZY ... -  《-》

Extra-anatomical hepatic artery reconstruction in living donor liver transplantation: can this procedure save hepatic grafts?

Graft hepatic arteries (HAs) are usually reconstructed with a recipient HA branch (anatomical HA reconstruction) in living donor liver transplantation (LDLT). Surgeons often encounter difficulties in reconstructing HAs, particularly when a recipient artery other than an HA branch must be used; this is known as extra-anatomical HA reconstruction. The outcomes of LDLT recipients with extra-anatomical HA reconstruction were retrospectively reviewed. Between October 1996 and October 2009, we performed primary LDLT 335 times, re-LDLT 8 times, and HA re-reconstruction 5 times for patients with HA complications. Thirty-three extra-anatomical HA reconstructions were performed in 22 patients with primary LDLT (6.6%), 4 patients with re-LDLT (50%), and 4 patients with HA re-reconstructions for HA complications (80%). In extra-anatomical HA reconstructions, we used 12 right gastroepiploic arteries, 6 right gastric arteries, 5 gastroduodenal arteries, 2 left gastric arteries, 2 splenic arteries, 2 cystic arteries, and 4 interposition grafts as recipient inflow arteries. Only 1 HA-related complication, the formation of an aneurysm, occurred after extra-anatomical HA reconstruction. The overall graft and patient survival probabilities after primary LDLT with extra-anatomical HA reconstruction were comparable to those after LDLT with anatomical HA reconstruction, although approximately half of the patients with extra-anatomical HA reconstruction suffered anastomotic biliary strictures. Therefore, extra-anatomical HA reconstruction can be safely performed through the proper selection of recipient arteries and the use of interposition grafts. These procedures can save hepatic grafts, even when recipient HAs cannot be used as inflow arteries.

Uchiyama H ，Shirabe K ，Taketomi A ，Soejima Y ，Ninomiya M ，Kayashima H ，Ikegami T ，Maehara Y ... -  《-》