ABSTRACT
Objective To evaluate the effect of different techniques of hepatic artery reconstruction on postoperative hepatic artery complications and clinical prognosis in liver transplantation. Methods Clinical data of 140 liver transplant recipients were retrospectively analyzed. All recipients were divided into the conventional hepatic artery reconstruction group (n=123) and special hepatic artery reconstruction group (n=17) according to hepatic artery reconstruction methods. Intraoperative and postoperative clinical indexes, the incidence of postoperative hepatic artery complications and survival rate were compared between two groups. Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at postoperative 1 d, total bilirubin (TB) at postoperative 7 d and prothrombin time international normalized ratio (PT-INR) at postoperative 30 d in special hepatic artery reconstruction group were higher than those in conventional hepatic artery reconstruction group, and the differences were statistically significant (all P < 0.05). There were no significant differences in the operation time, anhepatic phase, intraoperative blood loss, intraoperative transfusion volume of red blood cells, cold or warm ischemia time, the length of intensive care unit (ICU) stay, the length of hospital stay and postoperative blood flow of liver allograft between two groups (all P > 0.05). In the conventional hepatic artery reconstruction group, 5 recipients developed hepatic artery complications, whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group, with no significant difference between two groups (P > 0.05). In the special hepatic artery reconstruction group, the 1-, 3- and 5-year cumulative survival rates were equally 82.4%, compared with 85.0%, 78.9% and 75.6% in the conventional hepatic artery reconstruction group, respectively. There was no significant difference between two groups (all P > 0.05). Conclusions When hepatic artery variations and (or) lesions are detected in donors and recipients, use of special hepatic artery reconstruction may effectively restore the hepatic arterial blood flow of liver allograft after liver transplantation, and will not affect the incidence of hepatic artery complications and survival rate of the recipients following liver transplantation.
ABSTRACT
Objective To study preliminarily on the value of real-time three-dimensional contrast-enhanced ultrasound (RT-3D-CEUS ) for the diagnosis of hepatic artery complications after liver transplantation.Methods From April to July in 201 4,a total of 1 8 liver transplant recipients were examined 29 times,by color doppler ultrasound,contrast-enhanced ultrasound (2D-CEUS)and RT-3D-CEUS.The successful rate of RT-3D-CEUS was calculated.And the image quality and the diagnosis of hepatic artery complications were evaluated.Results In the 29 times of RT-3D-CEUS examination,the successful rate was 93% (27 /29).The image quality of RT-3D-CEUS got 3 points for 1 4 times,2 points for 1 3 times and 1 point for 2 times.In 6 cases who were diagnosed hepatic artery stenosis by RT-3D-CEUS,4 cases were first diagnosed by RT-3D-CEUS and confirmed by CTA,and 2 cases were diagnosed by CTA or DSA before RT-3D-CEUS.Conclusions The RT-3D-CEUS examination can get intuitive and clear images,which has clinical application value in evaluating hepatic artery complications after liver transplantation.
ABSTRACT
PURPOSE: The aim of this study is to analyze the outcome of a single hepatic artery anastomosis among multiple graft arteries in living donor liver transplantation. METHODS: A total of 153 LDLTs were performed at Seoul National University Hospital between January 1999 and December 2002. Thirty four cases (22.2%) of grafts were fed by multiple hepatic arteries. Twenty cases which were fed by left hepatic artery and middle hepatic artery, one intraoperative expired case and one case which was performed two hepatic arteries anastomosis were excluded in our study. Eight cases with two left hepatic arteries and 4 cases with two right hepatic arteries were reviewed. Hepatic artery anastomosis was carried out under operating microscope using interrupted Carrel's technique. In case of the presence of pulsatile back- flow after single hepatic artery anastomosis, the other hepatic artery was ligated. The median period of follow-up was 35 (26~58) months. RESULTS: There was no mortality due to complications associated with hepatic artery. In 11 cases, the adequate blood flow was verified daily for seven days after transplantation by means of Doppler ultrasonography. In 7 cases, intrahepatic arteries of donors seen on the preoperative CT aniography were confirmed at the same site on the postoperative CT angiography of recipients. Reoperation was performed for a one-year old child due to hepatic artery obstruction at the 11th postoperative day and she experienced acute rejection twice and steroid pulse therapy was performed. But she expired at the 107th postoperative day due to graft failure despite intact hepatic arterial flow on liver doppler sonography. CONCLUSION: Single hepatic artery anastomosis among multiple graft arteries had no complication. Thus single hepatic artery anastomosis among multiple graft arteries when pulsatile back flow existed, is safe and convenient method.