Hepatic artery microvascular anastomosis in pediatric living donor liver transplantation: a review of 35 consecutive cases by a single microvascular surgeon.

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.