Microsurgical reconstruction of hepatic artery in living donor liver transplantation:experiences and lessons

BACKGROUND:Hepatic artery(HA) reconstruction is one of the key steps for living donor liver transplantation(LDLT).The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe.METHODS:We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique.The reconstructions were completed by either a plastic surgeon or a transplant surgeon.RESULTS:The rate of HA thrombosis was 2%(2/101).The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon.For a graft with duplicate arteries,we considered no branches should be discarded even with a positive clamping test.CONCLUSIONS:HA reconstruction without clamping the graft artery is a feasible and simplified technique,which can be mastered by transplant surgeons with considerable microsurgical training.