Hepatic artery reconstruction in living donor liver transplantation: Running suture under surgical loupes by cardiovascular surgeons in 180 recipients

P. C. Li, L. B. Jeng*, H. R. Yang, C. C. Lee, K. S. Poon, T. H. Chen, C. C. Yeh, H. C. Lai, W. P. Su, C. Y. Peng, Y. F. Chen, Y. J. Ho

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

13 Scopus citations

Abstract

Objectives: The aim of our study was to retrospectively investigate the outcomes of hepatic artery (HA) reconstruction by cardiovascular surgeons in adult-to-adult living donor liver transplantation (A-A LDLT). Methods: From April 2007 to April 2011, 187 recipients underwent A-A LDLT. After excluding seven ABO-incompatible transplant recipients, we reviewed the courses of 180 patients including 125 men and 55 women of mean age 52.5 ± 9.2 years (range = 2371). One hundred seventy-seven patients received right-lobe grafts with inclusion of middle hepatic vein (MHV); two, right-lobe grafts without MHV; and one, left-lobe graft. A continuous, single-stitch, running suture with the parachute technique was used for HA reconstruction. The anastomosis was performed by cardiovascular surgeons employing surgical loupes with 4.5× magnification. Results: The mean time for an arterial reconstruction was 10.7 ± 4.0 minutes (median = 10, range = 430). Hepatic arterial thrombosis (HAT) was encountered in 3 (1.66%) patients. One HAT that developed on postoperative day 1 was successfully rescued by the intra-arterial infusion of urokinase. Another patient required reoperation due to a redundant kinked HA. A third HAT patient underwent successful retransplantation with a cadaveric graft on postoperative day 6. In our series, no delayed HAT was detected and no recipient deaths were related to HAT. Conclusion: HA reconstruction with a running suture under surgical loupes is a feasible technique in A-A LDLT. A speedy reconstruction can be performed by an experienced cardiovascular surgeon with a low incidence of HAT.

Original languageEnglish
Pages (from-to)448-450
Number of pages3
JournalTransplantation Proceedings
Volume44
Issue number2
DOIs
StatePublished - 03 2012
Externally publishedYes

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