A novel end-to-side anastomosis technique for hepatic rearterialization in rat orthotopic liver transplantation to accommodate size mismatches between vessels.

BACKGROUND/AIMS: We present our modification of a sutured arterial anastomosis in orthotopic rat liver transplantation as well as a literature survey and analysis of the existing techniques of rearterialization with regard to technical difficulties and potential limitations.

METHODS

The donor common hepatic artery (CHA) was anastomosed to the enlarged lumen of the recipient proper hepatic artery (PHA), tailored to match the size of the donor CHA, with an end-to-side interrupted suture technique. Vascular patency of hepatic rearterialization was assessed both intraoperatively and at the time the liver grafts were harvested (postoperative days 2 and 28). The effect of arterialization on hepatic morphology was confirmed by histological examination and compared to nonarterialized rat orthotopic liver transplantation.

RESULTS

The CHAs had a significantly larger diameter (up to 3-fold) compared to the PHAs, which represents a considerable size mismatch. The anastomosis procedure including the size adaptation required 15-25 min. All anastomoses were patent immediately, 5 min after rearterialization and at both harvest time points. The liver lobular architecture was intact in the rearterialized group, whereas a moderate degree of bile duct proliferation and portal/lobular lymphocytic infiltration were observed in the nonarterialized group.

CONCLUSION

The new technique is a time-consuming and microsurgically challenging but universally applicable and robust procedure accommodating even a substantial mismatch in vessel diameter.