Complications of arterial reconstruction in living donor liver transplantation: A single-center experience

Hiroaki Matsuda, Takahito Yagi, Hiroshi Sadamori, Hiroyoshi Matsukawa, Susumu Shinoura, Hiroshi Murata, Yuzo Umeda, Noriaki Tanaka

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Purpose. Microsurgical reconstruction of the fine hepatic arteries (HA) reduces the chance of complications in living donor liver transplantation (LDLT). We reviewed HA reconstructions and analyzed their complications and treatment in a single center. Methods. Between August 1996 and September 2004, we performed LDLT on 71 adults and 19 children. Patients received a lateral segment graft (n = 16), a left lobe graft (n = 11), an extended left lobe graft (n = 12), or a right lobe graft (n = 51). Results. Hepatic artery reconstruction was performed by end-to-end anastomosis under an operating microscope in all except five adults who received right lobe grafts with loupe magnification. Arterial complications developed in 5 (5.6%) of the 90 patients. Three patients required reanastomosis during their primary operation because of HA thrombosis, anastomotic kinking, and stenosis, respectively. There were three postoperative complications: an anastomotic stenosis, revised by percutaneous transluminal angioplasty; rupture of an HA pseudoaneurysm, treated by embolization; and anastomotic kinking, revised by reanastomosis. The patient with the pseudoaneurysm died of arterial complications. Multivariate analysis of cases before (4/13, 30.8%) and after 2000 (1/77, 1.3%) revealed that surgical experience was the only significant factor in reducing the incidence of HA complications (P = 0.007). Conclusion. Case number-dependent anastomotic reliability using microsurgical techniques is important for safer arterial reconstruction.

Original languageEnglish
Pages (from-to)245-251
Number of pages7
JournalSurgery Today
Volume36
Issue number3
DOIs
Publication statusPublished - Mar 2006

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Living Donors
Hepatic Artery
Liver Transplantation
Transplants
False Aneurysm
Pathologic Constriction
Angioplasty
Rupture
Thrombosis
Multivariate Analysis
Incidence

Keywords

  • Arterial complications
  • Doppler ultrasonography
  • Living donor liver transplantation
  • Microsurgical reconstruction

ASJC Scopus subject areas

  • Surgery

Cite this

Complications of arterial reconstruction in living donor liver transplantation : A single-center experience. / Matsuda, Hiroaki; Yagi, Takahito; Sadamori, Hiroshi; Matsukawa, Hiroyoshi; Shinoura, Susumu; Murata, Hiroshi; Umeda, Yuzo; Tanaka, Noriaki.

In: Surgery Today, Vol. 36, No. 3, 03.2006, p. 245-251.

Research output: Contribution to journalArticle

Matsuda, Hiroaki ; Yagi, Takahito ; Sadamori, Hiroshi ; Matsukawa, Hiroyoshi ; Shinoura, Susumu ; Murata, Hiroshi ; Umeda, Yuzo ; Tanaka, Noriaki. / Complications of arterial reconstruction in living donor liver transplantation : A single-center experience. In: Surgery Today. 2006 ; Vol. 36, No. 3. pp. 245-251.
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AB - Purpose. Microsurgical reconstruction of the fine hepatic arteries (HA) reduces the chance of complications in living donor liver transplantation (LDLT). We reviewed HA reconstructions and analyzed their complications and treatment in a single center. Methods. Between August 1996 and September 2004, we performed LDLT on 71 adults and 19 children. Patients received a lateral segment graft (n = 16), a left lobe graft (n = 11), an extended left lobe graft (n = 12), or a right lobe graft (n = 51). Results. Hepatic artery reconstruction was performed by end-to-end anastomosis under an operating microscope in all except five adults who received right lobe grafts with loupe magnification. Arterial complications developed in 5 (5.6%) of the 90 patients. Three patients required reanastomosis during their primary operation because of HA thrombosis, anastomotic kinking, and stenosis, respectively. There were three postoperative complications: an anastomotic stenosis, revised by percutaneous transluminal angioplasty; rupture of an HA pseudoaneurysm, treated by embolization; and anastomotic kinking, revised by reanastomosis. The patient with the pseudoaneurysm died of arterial complications. Multivariate analysis of cases before (4/13, 30.8%) and after 2000 (1/77, 1.3%) revealed that surgical experience was the only significant factor in reducing the incidence of HA complications (P = 0.007). Conclusion. Case number-dependent anastomotic reliability using microsurgical techniques is important for safer arterial reconstruction.

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