From the Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey.
Exp Clin Transplant. 2022 May;20(5):495-499. doi: 10.6002/ect.2015.0108. Epub 2016 Jan 14.
We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant.
Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 living-donor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively.
A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anas-tomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%.
According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.
本研究旨在探讨活体肝移植中双肝动脉重建的处理方法。
自 2002 年 1 月至 2014 年 6 月，在马拉蒂亚因努大学肝移植研究所共进行了 1036 例活体肝移植。983 例活体肝移植采用单肝动脉供肝，53 例供肝带有双肝动脉分支。所有双肝动脉分支供肝均为右叶供肝。回顾性分析接受双肝动脉分支供肝受体的肝动脉吻合技术及其他临床资料。
43 例受体行双肝动脉吻合，10 例因非优势肝动脉分支结扎而行单吻合。在 40 例受体中，将供肝的双肝动脉分支与受体的右、左肝动脉吻合；在其余 3 例受体中，将供肝的双肝动脉分支与受体的右肝动脉和较大的 4 段肝动脉吻合。术后 3 例发生与肝动脉吻合相关的并发症：肝动脉血栓形成 1 例，肝动脉瘤 1 例，肝动脉狭窄 1 例。1 例肝动脉瘤患者立即进行了再次移植，1 例肝动脉血栓形成患者复发并需要再次移植，术后第 10 天进行了血栓切除术，1 例肝动脉狭窄患者接受保守治疗。在本研究中，双肝动脉吻合相关并发症的发生率为 6.9%。
根据我们的经验，双肝动脉吻合不会增加肝动脉血栓形成的风险，对于有活体肝移植肝血管重建经验的外科医生来说，该手术是安全的。
