Clinical impact of right accessory hepatic artery injury in deceased donor livers

Background Right accessory hepatic artery (RAHA) injury at retrieval is a rare complication of deceased liver procurement. Arterial reconstruction is often required under these circumstances which could potentially increase the risk of hepatic artery thrombosis (HAT). The aim of this study is to investigate whether RAHA injury affects the incidence of HAT, early biliary complications, or 3-month graft and patient survival rates. Methods All adult liver transplants performed between 1994 and February 2007 at Addenbrooke's Hospital, Cambridge, UK were considered for inclusion in the study. Grafts were divided into three groups depending on the presence of RAHA and injury (Group 1: normal anatomy and single hepatic artery anastomosis; Group 2: RAHA requiring reconstruction; Group 3: RAHA injury requiring reconstruction). Results Eight hundred and forty-four liver transplants were included in the study (Group 1: 654 grafts; Group 2: 63 grafts; Group 3: 14 grafts). The incidence of HAT (Group 1, 2.9%; Group 2, 6.4%; Group 3, 14.3%) was significantly different between the three groups (P = 0.01); biliary complications at 3 months (Group 1, 7.1%; Group 2, 11.1%; Group 3, 7.1%) were not significantly different. Graft and patient survival at 3 months were significantly worse in Group 3 when compared with Group 2 (61.5 vs. 88.3%, P = 0.01; 81.8 vs. 98.2%, P = 0.02). Conclusion This is the first study analysing the clinical impact of RAHA injury during liver procurement. We conclude that the use of liver grafts with RAHA injury does result in a higher HAT rate and is also associated with lower graft and patient survival rates at 3 months.