Hara Takanobu, Soyama Akihiko, Matsushima Hajime, Hamada Takashi, Kinoshita Ayaka, Imamura Hajime, Yamashita Mampei, Satoh Ayaka, Migita Kazushige, Kawaguchi Yuta, Adachi Tomohiko, Takatsuki Mitsuhisa, Eguchi Susumu
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan.
Ann Transplant. 2025 Jan 7;30:e946135. doi: 10.12659/AOT.946135.
BACKGROUND Recipient hepatic arteries are generally used for arterial reconstructions in living donor liver transplantation. When the hepatic arteries are not feasible, the right gastroepiploic artery is one of the options for arterial reconstructions. In this study, we evaluate the feasibility of using the right gastroepiploic artery and report the analyzed retrospective patient outcomes. MATERIAL AND METHODS We included 324 patients who underwent primary living donor liver transplantation between August 1997 and December 2023. The rates of complications and surgical outcomes for different arteries used for reconstruction were compared between the groups. RESULTS For primary arterial reconstruction, the right gastroepiploic artery was used in 18 patients. The incidence of arterial complications and biliary strictures was higher than in the remaining 306 patients (P=0.01 and P=0.21, respectively). The 1-year and 5-year graft survival rates were 83.3% and 77.8% in the right gastroepiploic artery group, and 83.7% and 70.1% in the hepatic artery group, respectively (P=0.58). Eleven patients underwent arterial re-reconstruction secondary to arterial complications. The right gastroepiploic artery was used for the first time in 7 of these patients because the hepatic arteries were not reusable. Arterial complications after arterial re-reconstruction occurred in 4 patients (36.4%). CONCLUSIONS Arterial reconstruction using the right gastroepiploic artery was an effective option when the hepatic arteries were not suitable options, as it offered graft outcomes comparable to those of hepatic artery reconstruction, despite an increased risk of arterial and biliary complications.
在活体肝移植中，受体肝动脉通常用于动脉重建。当肝动脉不可行时，胃网膜右动脉是动脉重建的选择之一。在本研究中，我们评估了使用胃网膜右动脉的可行性，并报告了回顾性分析的患者结局。
我们纳入了1997年8月至2023年12月期间接受初次活体肝移植的324例患者。比较了不同重建动脉组之间的并发症发生率和手术结局。
对于初次动脉重建，18例患者使用了胃网膜右动脉。动脉并发症和胆道狭窄的发生率高于其余306例患者（分别为P = 0.01和P = 0.21）。胃网膜右动脉组的1年和5年移植物存活率分别为83.3%和77.8%，肝动脉组分别为83.7%和70.1%（P = 0.58）。11例患者因动脉并发症接受了再次动脉重建。其中7例患者首次使用了胃网膜右动脉，因为肝动脉不可再用。再次动脉重建后有4例患者发生动脉并发症（36.4%）。
当肝动脉不适合时，使用胃网膜右动脉进行动脉重建是一种有效的选择，因为尽管动脉和胆道并发症风险增加，但它提供的移植物结局与肝动脉重建相当。
