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| Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons |
| Sheng Yan, Qi-Yi Zhang, Yu-Sheng Yu, Jiang-Juan He, Wei-Lin Wang, Min Zhang, Yan Shen, Jian Wu, Xiao Xu and Shu-Sen Zheng |
Hangzhou, China
Author Affiliations: Division of Hepatobiliary and Pancreatic Surgery; Department of Surgery; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health; and Key Laboratory of Organ Transplantation Zhejiang Province, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China (Yan S, Zhang QY, Yu YS, He JJ, Wang WL, Zhang M, Shen Y, Wu J, Xu X and Zheng SS)
Corresponding Author: Shu-Sen Zheng, MD, PhD, FACS, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China (Tel: 86-571-87236570; Email: shusenzheng@zju.edu.cn) |
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Abstract 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.
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2009, Vol. 8 
