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Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe

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Transplant International

Abstract

Use of operative microscopy (OM) has dramatically reduced the incidence of hepatic artery thrombosis (HAT) in children undergoing segmental liver transplantation. We used OM (12–16×) in our early experience. We changed to high power loupe magnification (6×) after 14 cases. We examined our experience with microvascular hepatic artery reconstruction in 28 consecutive children (<18 years) who underwent living donor (LDLT) or split liver transplantation (SLT). Reconstructions were done with interrupted, end-to-end anastomoses with 8–0 polypropylene using microvascular techniques. Group 1 consisted of 14 children who underwent LDLT employing OM for the hepatic artery anastomosis. Group 2 consisted of the subsequent 14 children (11 LDLT, 3 SLT) in whom 6× loupe optics were used for the arterial anastomosis. Grafts included 25 left lateral segments, 2 left lobes, and 1 right lobe. Recipients’ median age was 1.0 years (range 3 months to 17 years). The mean follow-up time was 27.1 months. There were no cases of HAT. Variables of age, sex, graft type, number of Doppler ultrasound exams (DUS), and biliary complications were similar between groups. Microvascular hepatic artery reconstruction in children with 6× loupe magnification can yield results as good as operative microscopy.

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Acknowledgement

The Authors thank N. Erlich Lapid for her editorial assistance.

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Authors and Affiliations

  1. Center for Liver Disease and Transplantation, New York Presbyterian Hospital and Columbia University College of Physicians and Surgeons, New York, NY, USA

    James V. Guarrera, Prashant Sinha, Steven J. Lobritto, Robert S. Brown Jr, Milan Kinkhabwala & Jean C. Emond

  2. Department of Surgery, New York Presbyterian Hospital, 622 W 168th St., PH Box 411, New York , NY 10032, USA

    James V. Guarrera

Authors
  1. James V. Guarrera
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  2. Prashant Sinha
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  3. Steven J. Lobritto
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  4. Robert S. Brown Jr
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  5. Milan Kinkhabwala
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  6. Jean C. Emond
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Corresponding author

Correspondence to James V. Guarrera.

Additional information

This work was presented at the biennial meeting of the International Association for the Study of the Liver, April, 2002, Madrid, Spain

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Guarrera, J.V., Sinha, P., Lobritto, S.J. et al. Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe. Transpl Int 17, 585–588 (2004). https://doi.org/10.1007/s00147-004-0782-8

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  • DOI: https://doi.org/10.1007/s00147-004-0782-8

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