Anatomical and technical aspects of hepatic artery reconstruction in living donor liver transplantation

Background: We describe our experience with arterial reconstruction in living donor liver transplantation (LDLT) focusing on anatomic and technical aspects. Methods: From June 1994 to February 2003, 132 grafts were implanted in 130 LDLT recipients including 1 re-transplant and 1 dual graft transplantation. Donor and recipient records were retrospectively reviewed. Anatomical variations in graft arteries were classified as: Type I, single pedicle with (Ia) or without (Ib) aberrant artery (left hepatic artery (HA) from left gastric artery or right HA from superior mesenteric artery); Type II, double pedicles with (IIa) or without (IIb) aberrant artery; Type III, equal to or greater than 3 pedicles. Statistical analyses were carried out using Mann-Whitney U-test. Results: There were 72 male and 58 female recipients. The median age at transplantation was 3 years (range, 0.5 to 61). In left grafts, there were 34 Type Ia, 6 Type Ib, 33 Type IIa, 13 Type IIb, and 3 Type III; whereas in right grafts, there were 35 Type Ia, 6 Type Ib, 1 Type IIa, and 1 Type IIb. Two-in-one (2-in-1) segmental resection technique in graft HA harvest was carried out whenever there were tiny arteries supplying the donor graft. All HA reconstructions were done under microvascular techniques. There was no donor mortality and 1 recipient in-hospital mortality. There was no graft or patient loss due to HA occlusion. Donor complications included 3 biloma, 1 bile leak, 1 biliary stricture, and 1 late intestinal obstruction secondary to postoperative adhesions that were all successfully managed by non-operative interventions, except the biliary stricture that needed a revision to Roux-en-Y hepatico-jejunostomy. The 1-year and 5-year recipient survivals were 98% and 94%, respectively. Conclusions: Successful HA reconstruction can be safely carried out in LDLT recipients and live donors with multiple graft arteries using the 2-in-1 segmental resection of donor HA under microvascular techniques.