Hepatic artery reconstruction in living donor liver transplantation: strategy of the extension of graft or recipient artery

In living donor liver transplantation (LDLT) patients, the reconstruction of insufficiently long hepatic artery (HA) is difficult. However, no report has described the relationship between the length of HA and its reconstructive procedure. Herein, we aimed to identify the risk factors for the requirement of additional reconstructive procedures of direct anastomosis. Sixty-eight HA reconstructions in LDLT were conducted (37, men; 31, women). The causes of LDLT were hepatitis (n = 36), biliary atresia (n = 13), and primary biliary cirrhosis (n = 12). The graft HA comprised the right HA (n = 37) and left HA (n = 31). The recipient HA comprised the right HA (n = 39), left HA (n = 28), and right gastro-omental artery (n = 1). Two cases had graft HAs measuring 8 mm or more. The gap between the graft and recipient HA was 6 mm or more in nine cases. In 63 cases, direct anastomosis was performed. The extension of graft HA was performed using radial graft (n = 1) and two-step method (n = 1). The extension of recipient HA was performed using arterial graft (n = 2) extraanatomical recipient artery. Less than 8 mm length of graft HA (OR, 84) and 6 mm or greater gap between the recipient and graft HA (OR, 46.0) were identified as the risk factors for the need of additional procedures of direct anastomosis. We must always pay attention to the length of the graft and donor HA. To perform HA reconstruction safely, we should always consider using arterial grafts, extra-anatomical recipient artery, or the two-step method.