Yukihiro Sanada1, Shuji Hishikawa2, Noriki Okada3, Naoya Yamada3, Takumi Katano3, Yuta Hirata3, Yoshiyuki Ihara3, Taizen Urahashi3, Koichi Mizuta3. 1. Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan. yuki371@jichi.ac.jp. 2. Center for Development of Advanced Medical Technology, Jichi Medical University, Shimotsuke City, Japan. 3. Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
Abstract
PURPOSE: When living donor liver transplantation (LDLT) is performed on small infant patients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT. METHODS: Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient's abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion. RESULTS: Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 ± 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 ± 0.4 and 1.9 ± 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001). CONCLUSION: Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.
PURPOSE: When living donor liver transplantation (LDLT) is performed on small infantpatients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT. METHODS: Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient's abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion. RESULTS: Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 ± 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 ± 0.4 and 1.9 ± 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001). CONCLUSION: Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.
Entities:
Keywords:
Branch patch technique; Graft to recipient diameter ratio; Hepatic arterial reconstruction; Monosegmental graft; Pediatric living donor liver transplantation
Authors: E de Santibañes; L McCormack; J Mattera; J Pekolj; J Sívori; A Beskow; D D'Agostino; M Ciardullo Journal: Liver Transpl Date: 2000-01 Impact factor: 5.799
Authors: M R Shehata; S Yagi; Y Okamura; T Iida; T Hori; A Yoshizawa; K Hata; Y Fujimoto; K Ogawa; S Okamoto; Y Ogura; A Mori; S Teramukai; T Kaido; S Uemoto Journal: Am J Transplant Date: 2012-09-20 Impact factor: 8.086
Authors: F Di Benedetto; A Lauro; M Masetti; N Cautero; C Quintini; N De Ruvo; A Romano; G Guerrini; A Dazzi; G Molteni; A Siniscalchi; H Bertani; C M Miller; A D Pinna Journal: World J Surg Date: 2005-12 Impact factor: 3.352
Authors: Marcelo Enne; Lucio Filgueiras Pacheco-Moreira; Alexandre Cerqueira; Elizabeth Balbi; Marcia Halpern; João Luiz Pereira; Giuseppe Santalucia; Josther Gracia; Flavia Goncalves Coelho De Souza E Oliveira; Grace Kelly Paranhos; Rosalice Miecznikowski; Lucio José Auler De Faria; Rodrigo Pereira Diaz André; Adriana Caroli Bottino; José Manoel Martinho Journal: Pediatr Transplant Date: 2004-04