Hepatic Artery Reconstruction in Orthotopic Liver Transplantation and Postoperative Complications_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Shengning , LI Li , RAN Jianghua , LI Zhu , LI Xiaoyan , LIU Jing , CHEN Gang , CAO Haiying

Department of Hepatobiliary Surgery, The First People’s Hospital of Kunming, Kunming 650011, China;

Corresponding author：

Keywords：

Liver transplantation; Hepatic artery reconstruction; Microsurgery; Complication

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Objective　To explore the methods of hepatic artery reconstruction in orthotopic liver transplantation （LT） and prevention of relevant complications postoperatively.
Methods　A retrospective analysis was made for 31 cases orthotopic LT.
Results　The variations of hepatic arteries, which did not exist in the recipients, were found in 2 living donors. In 1 case, the accessory left hepatic artery arose from the left gastric artery. The ends of accessory left hepatic artery and left hepatic artery were made into one end through angioplasty on the back table. An interposition graft of donor great saphenous vein was used in the arterial reconstruction. In the other cases, the accessory right hepatic artery originating from gastroduodenal artery and the right hepatic artery were anastomosed to the branches of the hepatic artery of the recipient separately. In 1 patient receiving dual graft LT, the arteries of the grafts were nastomosed to the branches of the hepatic artery of the recipient separately. The diameters of hepatic arteries were less than 3 mm in 6 cases and more than 5 mm in 8 cases, the others were 3 to 5 mm. Donor iliac arterial graft was used for interposition between graft hepatic artery and recipient abdominal aorta in 1 case. Microsurgical vascular techniques was utilized in the reconstruction of hepatic artery. The time for an arterial reconstruction was 23-70 min 〔（31.46±9.07） min〕. The patients were followed up for 2-7 months. Hepatic artery stenosis was detected in 1 case on 32 d after LT, and no other arterial complications were found.
Conclusion　To attach importance to factors contributing to hepatic artery complications, the microsurgical technique applied in the reconstruction of the hepatic artery and appropriate anticoagulation can help to prevent the hepatic artery complications in LT.

Citation： ZHANG Shengning,LI Li,RAN Jianghua,LI Zhu,LI Xiaoyan,LIU Jing,CHEN Gang,CAO Haiying. Hepatic Artery Reconstruction in Orthotopic Liver Transplantation and Postoperative Complications. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(5): 564-568. doi: Copy

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10.	Marcos A, Killackey M, Orloff MS, et al. Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: evolution of anastomotic technique [Ｊ]. Liver Transpl, 2000; 9(6)∶570.
11.	Hevelke P, Grodzicki M, Nyckowski P, et al. Hepatic artery reconstruction prior to orthotopic liver transplantation [Ｊ]. Transplant Proc， 2003; 35(6)∶2253.
12.	Melada E， Maggi U， Rossi G, et al．Back-table arterial reconstructions in liver transplantation: single-center experience [Ｊ]. Transplant Proc， 2005； 37（６）∶2587.
13.	Soliman T, Bodingbauer M, Langer F, et al. The role of complex hepatic artery reconstruction in orthotopic liver transplantation [Ｊ]. Liver Transpl， 2003; 9(9)∶970.
14.	Okazaki M, Asato H, Takushima A, et al. Hepatic artery reconstruction with double-needle microsuture in living-donor liver transplantation [Ｊ]. Liver Transpl， 2006; 12(1)∶46.
15.	李文涛, 宋彬. 原位肝移植术后并发症的影像学评价 [Ｊ]. 中国普外基础与临床杂志, 2004; 11(1)∶76.
16.	Nolten A, Sproat IA. Hepatic artery thrombosis after liver transplantation: temporal accuracy of diagnosis with duplex US and the syndrome of impending thrombosis [Ｊ]. Radiology, 1996； 198(2)∶553.
17.	Guarrera JV, Sinha P, Lobritto SJ， et al. Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe [Ｊ]. Transpl Int, 2004； 17（10）∶585.
18.	Alper M, Gundogan H, Tokat C, et al. Microsurgical reconstruction of hepatic artery during living donor liver transplantation [Ｊ]. Microsurgery， 2005； 25（5）∶378.
19.	Wei WI, Lam LK, Ng RW, et al. Microvascular reconstruction of the hepatic artery in live donor liver transplantation: experience across a decade [Ｊ]. Arch Surg， 2004; 139(3)∶304.
20.	Ueno T, Jones G, Martin A, et al. Clinical outcomes from hepatic artery stenting in liver transplantation [Ｊ]. Liver Transpl， 2006; 12(3)∶422.

1. 　Wu YM， Voigt M， Rayhili S， et al. 肝上腔静脉成形术联合肝后腔静脉扩展术在肝移植中的应用: 首次115例经验报道 [Ｊ]. 外科理论与实践, 2002; 7(2)∶116.
2. 　郑树森, 徐骁. 肝脏移植中的肝动脉并发症及其对策 [Ｊ]. 中国普外基础与临床杂志, 2003; 10(4)∶313.
3. 　Silva MA, Jambulingam PS, Gunson BK, et al. Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom [Ｊ]. Liver Transpl， 2006; 12(1)∶146.
4. 　Ikegami T, Hashikura Y, Nakazawa Y, et al. Risk factors contributing to hepatic artery thrombosis following living-donor liver transplantation [Ｊ]. J Hepatobiliary Pancreat Surg， 2006; 13(2)∶105.
5. 　Del Gaudio M, Grazi GL, Ercolani G, et al. Outcome of hepatic artery reconstruction in liver transplantation with an iliac arterial interposition graft [Ｊ]. Clin Transplant， 2005; 19(3)∶399.
6. 　Asonuma K, Ohshiro H, Izaki T， et al． Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery [Ｊ]. Transpl Int， 2004； 17（10）∶639.
7. 　Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases [Ｊ]. Ann Surg， 1994; 220(1)∶50.
8. 　Alonso-Torres A, Fernandez-Cuadrado J, Pinilla I， et al. Multidetector CT in the evaluation of potential living donors for liver transplantation [Ｊ]. Radiographics， 2005； 25(4)∶1017.
9. 　Sahani D, Mehta A, Blake M, et al. Preoperative hepatic vascular evaluation with CT and MR angiography: implications for surgery [Ｊ]. Radiographics， 2004； 24(5)∶1367.
10. 　Marcos A, Killackey M, Orloff MS, et al. Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: evolution of anastomotic technique [Ｊ]. Liver Transpl, 2000; 9(6)∶570.
11. 　Hevelke P, Grodzicki M, Nyckowski P, et al. Hepatic artery reconstruction prior to orthotopic liver transplantation [Ｊ]. Transplant Proc， 2003; 35(6)∶2253.
12. 　Melada E， Maggi U， Rossi G, et al．Back-table arterial reconstructions in liver transplantation: single-center experience [Ｊ]. Transplant Proc， 2005； 37（６）∶2587.
13. 　Soliman T, Bodingbauer M, Langer F, et al. The role of complex hepatic artery reconstruction in orthotopic liver transplantation [Ｊ]. Liver Transpl， 2003; 9(9)∶970.
14. 　Okazaki M, Asato H, Takushima A, et al. Hepatic artery reconstruction with double-needle microsuture in living-donor liver transplantation [Ｊ]. Liver Transpl， 2006; 12(1)∶46.
15. 　李文涛, 宋彬. 原位肝移植术后并发症的影像学评价 [Ｊ]. 中国普外基础与临床杂志, 2004; 11(1)∶76.
16. 　Nolten A, Sproat IA. Hepatic artery thrombosis after liver transplantation: temporal accuracy of diagnosis with duplex US and the syndrome of impending thrombosis [Ｊ]. Radiology, 1996； 198(2)∶553.
17. 　Guarrera JV, Sinha P, Lobritto SJ， et al. Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe [Ｊ]. Transpl Int, 2004； 17（10）∶585.
18. 　Alper M, Gundogan H, Tokat C, et al. Microsurgical reconstruction of hepatic artery during living donor liver transplantation [Ｊ]. Microsurgery， 2005； 25（5）∶378.
19. 　Wei WI, Lam LK, Ng RW, et al. Microvascular reconstruction of the hepatic artery in live donor liver transplantation: experience across a decade [Ｊ]. Arch Surg， 2004; 139(3)∶304.
20. 　Ueno T, Jones G, Martin A, et al. Clinical outcomes from hepatic artery stenting in liver transplantation [Ｊ]. Liver Transpl， 2006; 12(3)∶422.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Hepatic Artery Reconstruction in Orthotopic Liver Transplantation and Postoperative Complications

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