PURPOSE: Atypical variants of the hepatic artery are common and pose a technical challenge for normothermic machine perfusion (NMP). The transplant surgeon has three options when confronted with hepatic arterial variation in a liver graft to be subjected to NMP: to perform arterial reconstruction (i) prior, (ii) during, or (iii) following NMP. METHODS: Herein, we report our experience and technical considerations with pre-NMP reconstruction. Out of 52 livers, 9 had an atypical hepatic artery (HA): 3 replaced right HA, 3 replaced left HA, 1 accessory left HA, 1 accessory left and right HA, and 1 replaced left and right HA. RESULTS: Reconstruction was conducted during back-table preparation. A single vascular conduit was created in all grafts to allow single arterial cannulation for NMP, necessitating only one arterial anastomosis within the recipient. All grafts were subjected to NMP and subsequently successfully transplanted. CONCLUSION: Our approach is being advocated for as it preserves the ability to alter the reconstruction in case of problems resulting from the reconstruction itself, thereby allowing functional evaluation of the reconstruction prior transplantation, permitting simultaneous reperfusion in the recipient, and providing the shortest possible duration for vascular reconstruction once the graft is rewarming non-perfused within the recipient. In addition, in light of the frequency of technically demanding reconstructions with very small vessels, we consider our technique beneficial as the procedure can be performed under ideal conditions at the back-table.
PURPOSE: Atypical variants of the hepatic artery are common and pose a technical challenge for normothermic machine perfusion (NMP). The transplant surgeon has three options when confronted with hepatic arterial variation in a liver graft to be subjected to NMP: to perform arterial reconstruction (i) prior, (ii) during, or (iii) following NMP. METHODS: Herein, we report our experience and technical considerations with pre-NMP reconstruction. Out of 52 livers, 9 had an atypical hepatic artery (HA): 3 replaced right HA, 3 replaced left HA, 1 accessory left HA, 1 accessory left and right HA, and 1 replaced left and right HA. RESULTS: Reconstruction was conducted during back-table preparation. A single vascular conduit was created in all grafts to allow single arterial cannulation for NMP, necessitating only one arterial anastomosis within the recipient. All grafts were subjected to NMP and subsequently successfully transplanted. CONCLUSION: Our approach is being advocated for as it preserves the ability to alter the reconstruction in case of problems resulting from the reconstruction itself, thereby allowing functional evaluation of the reconstruction prior transplantation, permitting simultaneous reperfusion in the recipient, and providing the shortest possible duration for vascular reconstruction once the graft is rewarming non-perfused within the recipient. In addition, in light of the frequency of technically demanding reconstructions with very small vessels, we consider our technique beneficial as the procedure can be performed under ideal conditions at the back-table.
Authors: Rafael López-Andújar; Angel Moya; Eva Montalvá; Marina Berenguer; Manuel De Juan; Fernando San Juan; Eugenia Pareja; Juan José Vila; Francisco Orbis; Martín Prieto; José Mir Journal: Liver Transpl Date: 2007-10 Impact factor: 5.799
Authors: Kim M Olthoff; Laura Kulik; Benjamin Samstein; Mary Kaminski; Michael Abecassis; Jean Emond; Abraham Shaked; Jason D Christie Journal: Liver Transpl Date: 2010-08 Impact factor: 5.799
Authors: David Nasralla; Constantin C Coussios; Hynek Mergental; M Zeeshan Akhtar; Andrew J Butler; Carlo D L Ceresa; Virginia Chiocchia; Susan J Dutton; Juan Carlos García-Valdecasas; Nigel Heaton; Charles Imber; Wayel Jassem; Ina Jochmans; John Karani; Simon R Knight; Peri Kocabayoglu; Massimo Malagò; Darius Mirza; Peter J Morris; Arvind Pallan; Andreas Paul; Mihai Pavel; M Thamara P R Perera; Jacques Pirenne; Reena Ravikumar; Leslie Russell; Sara Upponi; Chris J E Watson; Annemarie Weissenbacher; Rutger J Ploeg; Peter J Friend Journal: Nature Date: 2018-04-18 Impact factor: 49.962
Authors: David Nasralla; Hanns Lembach; Hynek Mergental; Darius Mirza; Peter Friend; Paolo Muiesan; Mtpr Perera Journal: Transplant Direct Date: 2020-08-21
Authors: S A Karangwa; P Dutkowski; P Fontes; P J Friend; J V Guarrera; J F Markmann; H Mergental; T Minor; C Quintini; M Selzner; K Uygun; C J Watson; R J Porte Journal: Am J Transplant Date: 2016-06-13 Impact factor: 8.086