Arterial reconstruction in hepatic artery occlusions in adult living donor liver transplantation using gastric vessels

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Background.Alternatives to the hepatic artery (HA) are needed in liver transplantation when the native HA cannot be used or when HA complications develop. We describe the indications, technique, and results of our experience using the right gastroepiploic (RGEA) and left gastric (LGA) arteries as alternative HA inflow in adult-to-adult living donor liver transplantation (LDLT).Methods.From January 1999 to June 2006, 130 patients underwent primary adult-to-adult LDLT (excluding dual graft transplantations). Seven patients required an HA alternative due to hepatic arterial complication. The recipient and graft demographic characteristics, arterial complication, and alternate arteries used were analyzed.Results.One hundred twenty-six (126) patients received right lobe liver grafts and four received left lobe grafts. Four patients required an HA alternative due to intimal dissection of the recipient HA found during primary transplant, and three patients had salvage during re-operation for HA thrombosis. The RGEA was used in five patients and LGA in two patients. Four patients had no further complication on long-term follow-up. One patient had biliary stricture requiring intervention, and two patients had bile leak. One bile leak recipient had his bile leakage resolved spontaneously without sequelae. One patient with two graft HA reconstructed had graft loss due to bile leak and sepsis following re-operation for HA occlusion.Conclusion.The RGEA and LGA can be successfully used as alternative HA inflow for hepatic arterial revascularization with good results in LDLT. The method has the advantage of single anastomosis compared to an interposition graft.

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