Objective To summarize the experience of the prevention of early arterial compl ications after hepatic artery (HA) reconstruction in adult-to-adult l iving donor l iver transplantation (A-A LDLT). Methods Between January 2002and March 2008, 127 patients underwent A-A LDLT. Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft), there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years). All patients underwent microsurgical reconstruction of HA between grafts and recipients. The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases. Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases. Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric il iac vessels in 3 cases. Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom. No other arterial compl ication such as HA stenosis and aneurysm occurred in recipients. All patients were followed up 9-67 months. At 1, 2, and 3 years, actual survival rateswere 82.2%, 64.7%, and 59.2%. No death was related to HA compl ication in peri-operative period. Conclusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative compl ications of HA reconstruction.
Objective To investigate the significance of hepatic arterial reconstruction on the model of 40% small-for-size orthotopic liver transplantation in rats. Methods Modified two-cuff technique was applied to establish a rat model of 40% orthotopic liver transplantation. A total of 240 Sprague Dawley (SD) rats were randomly divided into 2 groups: reconstructive artery group and non-reconstructive artery group. One week survival rate was observed. Main indexes of liver function, histology and the expression of proliferative cell nuclear antigen (PCNA) of liver graft （by immunohistochemical method） were detected on day 1, 2, 4 and 7 after transplantation, respectively. Results One week survival rates of reconstructive artery group and non-reconstructive artery group were 65.0% (13/20) and 50.0% (10/20) respectively (Pgt;0.05). Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate from day 1 and peaked on day 2 after surgery in two groups. ALT in non-reconstructive artery group on day 2 and 4 were significantly higher than that in reconstructive artery group (P＜0.05). TB in non-reconstructive artery group on day 2 and 7 were significantly higher than that in reconstructive artery group (P＜0.05). Histological findings indicated that more diploid and polyploid hepatocytes and more gently dilation of central veins and hepatic sinusoids could be seen postoperatively in reconstructive artery group. The expression of PCNA of liver graft peaked on day 2 after surgery. The expression of PCNA of reconstructive artery group was higher on day 1 (P＜0.01) and lower on day 7 than that of non-reconstructive artery group after operation (P＜0.05). Conclusions Arterial reconstruction can improve liver function of liver grafts after small-for-size orthotopic liver transplantation, alleviate the histological changes and promote the regeneration of liver grafts quickly.
ObjectiveTo investigate the effect of recipient hepatic artery reconstruction site selection on early ischemic-type biliary lesion (ITBL) after liver transplantation. Methods The clinical data of 656 cadaver liver transplantation were collected retrospectively from January 2015 to January 2020 in the Liver Transplantation Center of West China Hospital of Sichuan University and the Institute of Organ Transplantation of Tongji Hospital Affiliated to Huazhong University of Science and Technology. Patients were divided into two groups according to the reconstruction sites of recipient arteries. The distal group was anastomosed at left hepatic artery, right hepatic artery or proper hepatic artery. The proximal group was anastomosed at the gastroduodenal artery, the common hepatic artery or the common hepatic artery-gastroduodenal artery bifurcation. To investigate the differences in the incidence of early postoperative complications between the two groups and the factors influencing the development of ITBL within one year after transplantation. Results Of 656 patients, 262 were in the distal group and 394 were in the proximal group. The incidence of hepatic artery thrombosis was lower in the proximal group than that in the distal group (χ²=5.675, P=0.017), while the differences in the incidences of ITBL-related graft failure and rejection-related graft failure were not statistically significant when compared (all P>0.05). Multivariate logistic regression results showed that hepatic artery thrombosis [OR=4.453, 95%CI (1.318, 15.050), P=0.016] and cold ischemia time >6 h [OR=1.844, 95%CI (1.014, 3.353), P=0.045] were risk factors for early postoperative ITBL in the liver transplant patients, while different hepatic artery reconstruction categories were not risk factors for ITBL [OR=1.166, 95% CI (0.630, 2.157), P=0.625]. Conclusion Hepatic artery anastomosis reconstruction with the recipient common hepatic artery, gastroduodenal artery, and Carrel flap at the common hepatic artery-gastroduodenal artery bifurcation can somewhat reduce the difficulty of anastomosis and does not increase the risk of postoperative ITBL.