Microvascular reconstruction of the hepatic artery in live donor liver transplantation - Experience across a decade

Hypothesis: Hepatic arterial anastomosis by means of a microvascular technique can be performed with a high success rate in live donor liver transplantation in adult recipients. Design: Retrospective analysis of data collected prospectively. Setting: Tertiary referral center. Patients: From September 28, 1993, through December 23, 2002, 28 children received left lateral segment grafts (n=23) or left lobe grafts (n=5), and 124 adults received left lobe (n=6) or right lobe (n=118) grafts. Microvascular technique was used for hepatic arterial anastomosis. Attention was paid to exposure, orientation of the axis of arterial ends, and matching of size. Long microinstruments were used for arterial ends deeply located inside an adult's abdominal cavity. An average of 16 stitches was used for a vessel anastomosis 3 mm in diameter. Interventions: Intraoperative and postoperative Doppler ultrasonography were performed. Main Outcome Measures: Hepatic artery thrombosis rate. Results: All hepatic arterial anastomoses were patent after reconstruction. Complications occurred in 3 patients. They had hepatic arterial thrombosis at 19 days, 25 days, and 3 months after liver transplantation. The overall complication rate was 2%. Conclusion: With attention to exposure, appropriate instruments, and experience, a low complication rate of 2% can be achieved in hepatic arterial anastomosis by using a microvascular technique, even in adult patients with the liver graft situated deeply in the abdominal cavity.