The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, No.07 CLC works road, Chromepet, Chennai, 600044, India.
Langenbecks Arch Surg. 2021 Sep;406(6):1943-1949. doi: 10.1007/s00423-021-02176-y. Epub 2021 Apr 20.
Need for routine reconstruction of all arteries in grafts with multiple arterial inflows remains an unsettled debate. The aim of following article is to review an anatomical basis of a decision-making strategy to deal with multiple arteries in living donor liver transplantation (LDLT).
LDLT performed between August 2009-2019 were included. Grafts were classified into grafts with single artery (group 1); multiple arteries, all reconstructed (group 2); and multiple arteries, one reconstructed (group 3). Frequency of double arteries in relation to graft type, type of reconstruction, incidence of arterial and biliary complications and survival was compared.
1086 LDLT were analysed (adults: 750, paediatric: 336). 1007 grafts (92.2%) had single artery (group 1), and 79 (7.8%) grafts had multiple arteries. All arteries were reconstructed in 19 (24%) patients (group 2), while 60 grafts (75.9%) had only one artery reconstructed (group 3). Left lobe (18.8%) and left lateral segments (10.7%) grafts were more likely to have multiple arteries (p = 0.001). The likelihood of reconstructing multiple arteries was similar in all graft types, 27.3% in right and 25% and 21.4% in left lobe and left lateral segments, respectively (p > 0.05). There was no difference in biliary complications (p = 0.85), hepatic artery thrombosis (p = 0.82), and post-surgical hospital stay (p = 0.38) between the three groups. The presence of multiple arteries or their selective reconstruction did not affect survival (p = 0.73).
Multiple arterial inflows are not an uncommon entity and demonstration of good hilar collateralization helps in avoiding unnecessary arterial reconstruction without adverse outcomes.
在有多个动脉流入的移植物中常规重建所有动脉仍然是一个悬而未决的争论。本文旨在回顾在活体肝移植（LDLT）中处理多个动脉的决策策略的解剖学基础。
纳入 2009 年 8 月至 2019 年期间进行的 LDLT。将移植物分为单动脉移植物（第 1 组）；多动脉，全部重建（第 2 组）；和多动脉，重建一条（第 3 组）。比较了双动脉的频率与移植物类型、重建类型、动脉和胆道并发症发生率和存活率的关系。
分析了 1086 例 LDLT（成人：750 例，儿科：336 例）。1007 个移植物（92.2%）有单动脉（第 1 组），79 个移植物（7.8%）有多个动脉。19 例（24%）患者的所有动脉均被重建（第 2 组），而 60 个移植物（75.9%）仅重建一条动脉（第 3 组）。左叶（18.8%）和左外侧段（10.7%）的移植物更容易有多条动脉（p = 0.001）。在所有移植物类型中，重建多条动脉的可能性相似，右叶为 27.3%，左叶和左外侧段分别为 25%和 21.4%（p > 0.05）。三组之间的胆道并发症无差异（p = 0.85）、肝动脉血栓形成（p = 0.82）和术后住院时间（p = 0.38）。有多条动脉或选择性重建动脉并不影响存活率（p = 0.73）。
多个动脉流入并不罕见，良好的肝门侧支循环显示有助于避免不必要的动脉重建，而不会产生不良后果。
