Impact of Hepatic Artery Variations and Reconstructions on the Outcome of Orthotopic Liver Transplantation.

Abstract:

BACKGROUND:Donor variational arteries often require complex reconstruction. METHODS:We analysed the incidence of different variations, types of arterial reconstructions and their impact on post-operative results from 409 patients undergoing liver transplantation at Karolinska Institute between 2007 and 2015. RESULTS:A total of 292 (71.4%) liver grafts had a standard hepatic artery (SHA), and 117 (28.6%) showed hepatic artery variants (HAV). 58% of HAV needed reconstruction. The main variations were variant left hepatic artery (45.3%) from the gastric artery; variant right hepatic artery (38.5%); and a triple combination of variant right and left hepatic artery and the proper hepatic artery from the common hepatic artery (12.8%); other 3.4%. Patients/graft survival and arterial complications were not different between SHA and HAV. Incidence of biliary stricture was numerically higher in left hepatic artery variants (p = 0.058) and in variants where no arterial reconstruction was performed (p = 0.001). Operation and arterial warm ischaemia time were longer in the HAV group. The need for intraoperative re-reconstruction was higher in the HAV group (p = 0.04). Intraoperative bleeding was larger after back-table reconstruction than with intraoperative reconstruction (p = 0.04). CONCLUSION:No overall differences were found between the HAV and the SHA groups. Occurrence of a variant left hepatic artery and HAV with no reconstruction seems to increase the risk of biliary strictures.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Karakoyun R,Romano A,Yao M,Dlugosz R,Ericzon BG,Nowak G

doi

10.1007/s00268-020-05406-4

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1954-1965

issue

6

eissn

0364-2313

issn

1432-2323

pii

10.1007/s00268-020-05406-4

journal_volume

44

pub_type

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