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Hepatic artery–related complications after live donor liver transplantation

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A Correction to this article was published on 16 February 2023

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Abstract

Background

Hepatic artery–related complications (HARC) after live donor liver transplantation (LDLT) is associated with high morbidity and mortality rate.

Methods

Prospectively maintained data from July 2011 to September 2020 was analyzed for etiology, detection, management, and outcome of HARC.

Results

Six hundred fifty-seven LDLT (adult 572/pediatrics 85) were performed during the study period. Twenty-one (3.2%) patient developed HARC; 16 (2.4%) hepatic artery thrombosis (HAT) and 5 (0.76%) non-thrombotic hepatic artery complication (NTHAC). Ninety percent (19/21) HARC were asymptomatic and detected on protocol Doppler. Median time to detection was day 4 (range − 1 to 35), which included 18 early (within 7 days) vs 3 late incidents. Only one pediatric patient had HAT. Seven patients underwent surgical revascularization, 11 had endovascular intervention and 3 with attenuated flow required only systemic anticoagulation. All NTHAC survived without any sequelae. Revascularization was successful in 81% (13/16) with HAT. Biliary complications were seen in 5 (23.8%); four were managed successfully. Overall mortality was 14.8% (3/21). The 1-year and 5-year survival were similar to those who did not develop HARC (80.9% vs 84.2%, p = 0.27 and 71.4% vs 75.19%, p = 0.36 respectively) but biliary complications were significantly higher (23.8% vs 14.2%, p = 0.03). On multivariate analysis, clockwise technique of arterial reconstruction was associated with decreased risk of HAT (1.7% vs 4.1% (p value − 0.003)).

Conclusion

Technical refinement, early detection, and revascularization can achieve good outcome in patients with HARC after LDLT.

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Data Availability

The data that support the findings of the present study are available within the article.

Change history

Abbreviations

ACLF:

Acute on chronic liver failure

ALF:

Acute liver failure

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

CD:

Clavien-Dindo grading

CLD:

Chronic liver disease

DDLT:

Deceased donor liver transplantation

DSA:

Digital subtraction angiography

ERCP:

Endoscopic retrograde cholangio-pancreatography

GDA:

Gastro-duodenal artery

GRWR:

Graft recipient weight ratio

HARC:

Hepatic artery–related complications

HAT:

Hepatic artery thrombosis

HJ:

Hepatico-jejunostomy

HTK:

Histidine-Tryptophan-Ketoglutarate

LAI:

Liver attenuation index

LT:

Liver transplantation

LDLT:

Living donor liver transplantation

NTHAC:

Non-thrombotic hepatic artery complications

PTBD:

Percutaneous trans-hepatic biliary drainage

RGE:

Right gastro epiploic artery

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Authors and Affiliations

  1. Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India

    Viniyendra Pamecha, Piyush Kumar Sinha, Nilesh Sadashiv Patil, Nihar Mohapatra, Anubhav Harshit Kumar & Sahil Gupta

  2. Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

    Amar Mukund

  3. Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

    Shalini Thapar

  4. Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

    Ashok Choudhury

  5. Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India

    Gaurav Sindwani

Authors
  1. Viniyendra Pamecha
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  2. Piyush Kumar Sinha
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  7. Ashok Choudhury
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  8. Gaurav Sindwani
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  9. Anubhav Harshit Kumar
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Contributions

Participated in research design: Viniyendra Pamecha. Participated in data collection: Viniyendra Pamecha, Piyush Kumar Sinha, Amar Mukund, Nilesh Patil, Nihar Mohapatra, Anubhav Kumar, Sahil Gupta. Participated in data analysis: Viniyendra Pamecha, Piyush Kumar Sinha, Sahil Gupta. Participated in the writing of the paper: Viniyendra Pamecha, Piyush Kumar Sinha, Sahil Gupta. Participated in the performance of the research: Viniyendra Pamecha, Piyush Kumar Sinha, Amar Mukund, Nilesh Patil, Nihar Mohapatra, Anubhav Kumar, Sahil Gupta, Shalini Thapar, Ashok Choudhury. Participated in critical analysis of paper: Viniyendra Pamecha, Piyush Kumar Sinha.

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Correspondence to Viniyendra Pamecha.

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Pamecha, V., Sinha, P.K., Mukund, A. et al. Hepatic artery–related complications after live donor liver transplantation. Langenbecks Arch Surg 408, 24 (2023). https://doi.org/10.1007/s00423-023-02759-x

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