Back-table reconstruction of the donor replaced right hepatic artery prior to liver transplantation: what is the real impact on arterial complications?
ABSTRACT 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.
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.
The two groups showed no statistical sig nificant 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.
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.
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ABSTRACT: BACKGROUND: During the past decade the number of livers recovered and transplanted from donation after circulatory death (DCD) donors has increased significantly. As reported previously, injuries are more frequent during kidney procurement from DCD than from donation after brain death (DBD) donors. This aim of this study was to compare outcomes between DCD and DBD with respect to liver injuries. METHODS: Data on liver injuries in organs procured between 2000 and 2010 were obtained from the UK Transplant Registry. RESULTS: A total of 7146 livers were recovered from deceased donors during the study, 628 (8·8 per cent) from DCD donors. Injuries occurred in 1001 procedures (14·0 per cent). There were more arterial (1·6 versus 1·0 per cent), portal (0·5 versus 0·3 per cent) and caval (0·3 versus 0·2 per cent) injuries in the DBD group than in the DCD group, although none of these findings was statistically significant. Capsular injuries occurred more frequently in DCD than DBD (15·6 versus 11·4 per cent; P = 0·002). There was no significant difference between DCD and DBD groups in liver discard rates related to damage. CONCLUSION: There were no differences in terms of vascular injuries between DCD and DBD livers, although capsular injuries occurred more frequently in DCD organs. Continuing the trend for increased frequency of DCD liver recovery, and ensuring that there is an adequately skilled surgical team available for procurement, is vital to improving the utilization of DCD livers. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.British Journal of Surgery 12/2012; · 4.84 Impact Factor