Overcoming Hepatic Artery Thrombosis After Living Donor Liver Transplantations: An Experience from Asan Medical Center

Background: Hepatic artery (HA) reconstruction in living donor liver transplantation (LDLT) is more technically demanding than deceased donor LT (DDLT) because of the small diameter and short HA stump of the partial liver graft. Hence, hepatic artery thrombosis (HAT) can occur infrequently even though the HA is reconstructed microscopically. HAT is closely related to graft failure and mortality. Therefore, HAT should be detected early and HA flow reconstituted using several arterial inflows. We successfully performed redo HA reconstruction in LDLT and report our management process and outcomes. Material/Methods: The right gastroepiploic artery (RGEA) was used in 15 patients, previous native HA in 3, and interposition graft from the aorta in 1. All HA reconstructions were performed under a microscope using the end-to-end interrupted suture method. We reviewed technical feasibility, cause of hepatic artery revision (HAR), patency of redo HA flow, graft salvage rate, time of revision, biliary complications, and mortality. Results: Ten of 21 cases were salvage LT. Biliary complications developed in 6 cases. The mean interval of HAR with the RGEA was 1.5+1.2 postoperative days. All patients were alive without lethal complications of HAT during the mean follow-up period of 23.3 months. In the other 6 cases of HAR without using the RGEA, we performed redo HA reconstruction after thrombectomy with the native right HA (n=2), right gastric artery, left HA, gastroduodenal artery, and jump graft from the aorta (n=1, respectively). Among them, 3 died from biliary sepsis, graft dysfunction from large-sized ischemic injury, and pneumonia. Conclusions: HAR with the RGEA is feasible for HAT management in LDLT patients without adequate hepatic arteries. When all inflows mentioned are unavailable, jump graft from the aorta using a cadaveric fresh iliac artery may be feasible.