Splenic artery transposition for hepatic arterial supply in living donor liver transplantation

Objective: To determine the safety and outcome of splenic artery(SA) transposition in extra-anatomic hepatic arterial reconstruction (HAR) in living donor liver transplantation(LDLT). Methods: We retrospectively compared the outcome of the ten liver recipients who underwent HAR with the transposed splenic artery (SA group) with a matched cohort of 40 recipients who underwent HAR with the standard hepatic artery (HA group) between March, 2019 and December, 2020 at liver transplantation department, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Pakistan. The comparison of recipients' and donor demographics, operative and graft characteristics, post-operative labs, Doppler ultrasound(USG) findings, and complications, along with 30-day mortality, and 1-year survival were reported for both groups. Results: The mean age of patients in the SA group was 42.80 +/- 7.510 and in the HA group was 43.73 +/- 8.171 years. The common indication of LDLT was viral hepatitis in both groups. The operative duration was longer in the SA group (597.50 +/- 41.3156 min) than in the HA group (530.75 +/- 66.502 min) with a significant p-value= 0.004. Similarly, blood loss was also more in the SA group (1635 +/- 226.139 ml) than in the HA group (1477.50 +/- 270.316 ml) (p-value= 0.096). The incidence of biliary and vascular complications, early allograft dysfunction, acute cellular rejection, 30-day mortality, and 1-year survival were comparable in both groups. Post-operatively splenectomy was not needed in any SA group recipients. Conclusion: The SA is easily approachable, suitable, and safe for HAR in the difficult situation of hepatic arterial flow inadequacy during LDLT due to its appropriate length, and good blood flow.