Right Gastroepiploic Artery Is the First Alternative Inflow Source for Hepatic Arterial Reconstruction in Living Donor Liver Transplantation

Background. Sufficient arterial flow after living donor liver transplantation (LDLT) is closely related to graft survival and prevention of postoperative complications. However, some unfavorable hepatic arterial conditions in recipients preclude reconstruction, requiring alternative stumps. We have used the right gastroepiploic artery (RGEA) as a first alternative for hepatic inflow. Methods. From January 2006 to December 2008, we performed 754 LDLTs including 28 cases of RGEA among hepatic arterial anastomoses. The arterial anastomosis was performed by an single surgeon under 859 a microscope using an end-to-end interrupted suture technique. RGEA was mobilized over 15 cm from the greater curvature of stomach and greater omentum. Results. The indications for RGEA use included severe hepatic arterial injury from previous transarterial chemoembolization (n = 14), need for additional arterial flow in dual-grafts LDLT (n = 13), poor blood flow from the recipient hepatic artery (n = 3), and arterial injury during hilar dissection (n = 3). The mean diameter of the isolated RGEA was 2.0 +/- 0.2 mm (range: 1.0-2.5). Most hepatic arterial anastomoses were performed with a significant size discrepancy of more than twofold. All reconstructed hepatic arterial flowes showed good; no complication was identified during the mean follow-up period of 56 months to date. Conclusions. Using RGEA as an alternative arterial inflow is a simple, reliable procedure for situations of inadequate recipient hepatic or multiple graft arteries.