Hepatic artery reconstruction and successful management of its complications in living donor liver transplantation using a right lobe.

BACKGROUND: The aim of the present study was to improve the techniques of hepatic artery (HA) reconstruction and to properly manage arterial complications after living donor liver transplantation (LDLT). METHODS: Prospectively collected data collected from 371 patients who underwent adult LDLT using a right lobe from January 2000 to August 2009 were retrospectively reviewed. RESULTS: Of 17 patients (4.6%, 17/371) with double HA stumps in the graft, 12 patients (70.6%) received dual HA reconstruction. HA complications were composed of thrombosis (n = 6), pseudoaneurysm (n = 2), and stenosis (n = 4), showing 3.2% (12/371) of incidence. In patients with HA thrombosis, whereas operative thrombectomies with re-anastomosis rescued all the grafts in early attack (n = 3, ≤1 wk), angiographic thrombolysis successfully reestablished the flow in patients with late attack (n = 3, >1 wk). In all patients with HA complications, except for one, all of our treatment modalities - operation and angiographic intervention - resulted in successful rescue of grafts and no patient received re-transplantation because of HA complications. CONCLUSION: Prompt diagnosis of HA complications by serial post-operative Doppler ultrasound and corresponding treatment strategies, including operative and radiological intervention, can rescue both grafts and patients without necessitating re-transplantation.