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Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with monosegmental grafts

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Abstract

Purpose

When living donor liver transplantation (LDLT) is performed on small infant patients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT.

Methods

Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient’s abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion.

Results

Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 ± 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 ± 0.4 and 1.9 ± 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001).

Conclusion

Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.

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Abbreviations

LT:

Liver transplantation

HAC:

Hepatic artery complication

LDLT:

Living donor liver transplantation

CT:

Computed tomography

PV:

Portal vein

GRDR:

Graft to recipient diameter ratio

POD:

Post-operative day

RHA:

Right hepatic artery

LHA:

Left hepatic artery

PHA:

Proper hepatic artery

GDA:

Gastroduodenal artery

MHA:

Middle hepatic artery

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Author information

Authors and Affiliations

  1. Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan

    Yukihiro Sanada, Noriki Okada, Naoya Yamada, Takumi Katano, Yuta Hirata, Yoshiyuki Ihara, Taizen Urahashi & Koichi Mizuta

  2. Center for Development of Advanced Medical Technology, Jichi Medical University, Shimotsuke City, Japan

    Shuji Hishikawa

Authors
  1. Yukihiro Sanada
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  2. Shuji Hishikawa
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  3. Noriki Okada
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  4. Naoya Yamada
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  5. Takumi Katano
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  6. Yuta Hirata
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  7. Yoshiyuki Ihara
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  8. Taizen Urahashi
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  9. Koichi Mizuta
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Corresponding author

Correspondence to Yukihiro Sanada.

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Funding

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Conflict of interest

The authors declare that they have no conflicts of interest.

Financial support

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author contributions

Study design: Yukihiro Sanada

Acquisition of data: Shuji Hishikawa, Noriki Okada, Naoya Yamada, Takumi Katano, Yuta Hirata, Yoshiyuki Ihara, and Taizen Urahashi

Analysis and interpretation: Yukihiro Sanada

Manuscript drafted by Yukihiro Sanada

Revision: Koichi Mizuta

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Sanada, Y., Hishikawa, S., Okada, N. et al. Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with monosegmental grafts. Langenbecks Arch Surg 402, 123–133 (2017). https://doi.org/10.1007/s00423-016-1479-z

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  • DOI: https://doi.org/10.1007/s00423-016-1479-z

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