[Role of anatomic variations and methods of hepatic artery reconstruction in the incidence of thrombosis following liver transplantation].

AIM

The aim of this study was to investigate the incidence of anatomic variations of hepatic artery (HA) in order to evaluate if anatomical anomalies may be associated with an increased incidence of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT). Moreover, we focused on arterial reconstructive technique associated with a low incidence of HAT.

METHODS

We reported a consecutive series of 687 OLT in 601 patients (1986-1999). Hepatic arterial reconstruction was variable and dependent upon donor and recipient anatomy, even if arterial anastomosis was mainly of two types: the end-to-end anastomosis (EEA), used in 340/687 OLT (49.4%) and the branch patch anastomosis (BPA), performed in 347/687 OLT (50.5%). Interrupted sutures of 7/0 polypropylene always were used.

RESULTS

The diagnosis of HAT was made in 17/687 patients (2.47%). Anomalous hepatic arteries were found in 5/17 cases (29.4%). In the EEA group HAT occurred in 12/340 patients (3.53%), whereas in the BPA group HAT was diagnosed in 5/347 cases (1.44%) (p = 0.078).

DISCUSSION

Anatomic variations of HA, most frequently observed, were the left hepatic artery originating from the left gastric artery (9.7-18%) and the right hepatic artery originating from the superior mesenteric artery (7.5-18%). There was no increased incidence of HA complications in the presence of HA anomalies in the donor. Moreover, the existence of an anomaly in the recipient HA was not important if it had appropriate size anf flow.

CONCLUSIONS

In our series, the branch patch technique, using the hepatic-gastroduodenal bifurcation, was our current preferred method of arterial anastomosis, with a HAT-rate of 1.44%.