Back-table Reconstruction of the Donor Replaced Right Hepatic Artery Prior to Liver Transplantation: What is the Real Impact on Arterial Complications?

Background/Aims: The aim of this study was to analyze the technique of reconstruction, prior to liver transplantation, of donor replaced right hepatic arteries and to study its impact on graft outcome. Methodology: Two groups of liver grafts were retrospectively examined. The first group (group 1) did not require any arterial reconstruction prior to liver transplantation (n=507). The second one (group 2) included grafts with right replaced hepatic arteries which required reconstruction (n=75). Patients' data were analyzed to evaluate the effect of the arterial reconstruction on the incidence of posttransplant mortality, arterial and biliary complications on one hand and patient and graft survivals on the other. We also made a comprehensive literature search to analyze the different approaches described to reconstruct such variation. Results: The two groups showed no statistical significant difference for early posttransplant mortality and arterial complications. Hepatic arterial thrombosis occurred in two cases in the group 2 (2.6%) and in four cases in group 1 (0.7%); p=0.17. Patient and graft survivals over the whole follow-up period were not significantly different between the two groups. The analysis of the literature found few publications dealing with reconstruction of right replaced hepatic arteries, though because various techniques were reported and the samples of patients were small, a preferred method could not clearly be identified. Conclusions: Graft arterial reconstruction of a right replaced hepatic artery using a safe and rigorous technique does not enhance the risk of arterial complications or graft loss and the technique using the GDA stump could be recommended for routine use.