Hepatic artery restoration (HAR) is critical for optimal liver transplant outcomes. For a study, researchers assessed transplant outcome improvement through ongoing technological advancements.
From 2008 to 2020, a single plastic surgeon conducted HAR in 1,448 living donor liver transplants. Difficult HARs have been described as graft or recipient hepatic artery ≤2 mm, intimal dissection of graft or recipient hepatic artery (HA), size difference (≥2 to 1), numerous hepatic arteries, inferior quality, and prompt redo during transplantation. Early vessel injury recognition, precise HA dissection, the use of clips to ligate branches, an oblique cut for all HARs, a modified funneling method for size discrepancy, liberal use of an alternative artery to replace a pathologic HA, and reconstruction of a second HA for grafts with dual hepatic arteries in the graft are just a few of the technique refinements.
Small HA (21.35%), size discrepancy (12.57%), many hepatic arteries (11.28%), suboptimal quality (31.1%), intimal dissection (20.5%), and urgent redo (5.18%) were the most difficult HARs. The total hepatic artery thrombosis (HAT) rate in the study was 3.04%. The average HAT rate in the previous four years (2017-2020) was 1.46% (6/408), which was statistically lower than the average HAT rate from 2008 to 2016 (39/1,040, 3.8%) with statistical significance (P=0.025). Anastomosis following trim back (9), rebuilding utilizing alternatives (19), and nonsurgical therapy with urokinase (9) were all used to treat posttransplant HAT.
The careful assessment of the HA under the surgical microscope and the selection of the right recipient HA are critical to the success of the reconstruction. They kept HA issues to a minimum by constantly improving technology.