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J Reconstr Microsurg 2009; 25(7): 439-443
DOI: 10.1055/s-0029-1223853
© Thieme Medical Publishers

Hepatic Artery Microvascular Anastomosis in Pediatric Living Donor Liver Transplantation: A Review of 35 Consecutive Cases by a Single Microvascular Surgeon

Andre Panossian1 , Ivan Diamond2 , Annie Fecteau2 , David Grant2 , Ronald Zuker2
  • 1Children's Hospital Los Angeles–Plastic Surgery, Los Angeles, California
  • 2Hospital for Sick Children, Sick Kids Transplant Center Toronto, Toronto, Ontario, Canada
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Publication History

Publication Date:
19 May 2009 (online)

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ABSTRACT

Early experience with living donor liver transplantation (LDLT) was often complicated by hepatic artery thrombosis (HAT), a devastating complication resulting in graft loss. Attempting to reduce the incidence of HAT, we undertook a retrospective review of all children at our institution undergoing LDLT between March 2000 and August 2007, with the hepatic artery anastomosis performed by a single microvascular surgeon. Transplant surgeons performed the remainder of the operation. Patient outcomes were evaluated, including 1-year arterial and biliary complications, as well as overall survival. End-to-end hepatic arterial anastomoses were performed in 35 patients (median age: 15 months). Median posttransplant follow-up was 39 months (range: 0 to 90 months). One patient with a diffuse coagulopathy was retransplanted for HAT; this patient also demonstrated portal and hepatic vein thromboses. Biliary complications occurred in seven patients: three leaks, one cholangitis, one nonspecific dilatation, and two strictures. The median posttransplant follow-up was 39 months (range: 0 to 90 months). One- and 5-year patient survival was 94% and 94%, respectively. Very low rates of HAT can be achieved with LDLT using microsurgical techniques for hepatic arterial anastomoses. Outstanding long-term liver graft function can be achieved after LDLT when plastic surgeons and transplant surgeons collaborate together to reduce technical complications.

KEYWORDS

Hepatic artery thrombosis - living donor liver transplantation - microsurgery

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Andre PanossianM.D. 

Children's Hospital Los Angeles–Plastic Surgery

4650 Sunset Blvd. MS #96, Los Angeles CA 90027

Email: apanossian@chla.usc.edu