An alternative technique for harvesting marginal liver grafts with a replaced or accessory right hepatic artery.

The presence of a replaced or accessory right hepatic artery (R/A RHA) originating from the superior mesenteric artery represents one of the most common anatomical vascular variants of the hepatic artery and comprises the most frequently injured vessels during liver harvesting. Vascular arterial injuries following liver procurement are associated with decreased patient and graft survival and higher retransplantation rates. We describe an alternative technique for harvesting marginal liver grafts with replaced or accessory right hepatic arteries in the absence of pancreatic procurement. The entire procedure is divided and schematically described in six steps for didactical purposes. This technique has been used in 72 liver harvests over a three-year period with no R/A RHA injury. The technical advantages and limitations of this alternative method are discussed.