Anatomical Basis for Selective Multiple Arterial Reconstructions in Living Donor Liver Transplantation.
Hepatic artery thrombosis
Hilar plate
LDLT (living donor living transplant)
Multiple graft arterial inflow
Multiple graft arteries
Selective reconstruction policy
Single graft artery reconstruction
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
29
12
2020
accepted:
12
04
2021
pubmed:
21
4
2021
medline:
2
10
2021
entrez:
20
4
2021
Statut:
ppublish
Résumé
Need for routine reconstruction of all arteries in grafts with multiple arterial inflows remains an unsettled debate. The aim of following article is to review an anatomical basis of a decision-making strategy to deal with multiple arteries in living donor liver transplantation (LDLT). LDLT performed between August 2009-2019 were included. Grafts were classified into grafts with single artery (group 1); multiple arteries, all reconstructed (group 2); and multiple arteries, one reconstructed (group 3). Frequency of double arteries in relation to graft type, type of reconstruction, incidence of arterial and biliary complications and survival was compared. 1086 LDLT were analysed (adults: 750, paediatric: 336). 1007 grafts (92.2%) had single artery (group 1), and 79 (7.8%) grafts had multiple arteries. All arteries were reconstructed in 19 (24%) patients (group 2), while 60 grafts (75.9%) had only one artery reconstructed (group 3). Left lobe (18.8%) and left lateral segments (10.7%) grafts were more likely to have multiple arteries (p = 0.001). The likelihood of reconstructing multiple arteries was similar in all graft types, 27.3% in right and 25% and 21.4% in left lobe and left lateral segments, respectively (p > 0.05). There was no difference in biliary complications (p = 0.85), hepatic artery thrombosis (p = 0.82), and post-surgical hospital stay (p = 0.38) between the three groups. The presence of multiple arteries or their selective reconstruction did not affect survival (p = 0.73). Multiple arterial inflows are not an uncommon entity and demonstration of good hilar collateralization helps in avoiding unnecessary arterial reconstruction without adverse outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Need for routine reconstruction of all arteries in grafts with multiple arterial inflows remains an unsettled debate. The aim of following article is to review an anatomical basis of a decision-making strategy to deal with multiple arteries in living donor liver transplantation (LDLT).
METHODS
METHODS
LDLT performed between August 2009-2019 were included. Grafts were classified into grafts with single artery (group 1); multiple arteries, all reconstructed (group 2); and multiple arteries, one reconstructed (group 3). Frequency of double arteries in relation to graft type, type of reconstruction, incidence of arterial and biliary complications and survival was compared.
RESULTS
RESULTS
1086 LDLT were analysed (adults: 750, paediatric: 336). 1007 grafts (92.2%) had single artery (group 1), and 79 (7.8%) grafts had multiple arteries. All arteries were reconstructed in 19 (24%) patients (group 2), while 60 grafts (75.9%) had only one artery reconstructed (group 3). Left lobe (18.8%) and left lateral segments (10.7%) grafts were more likely to have multiple arteries (p = 0.001). The likelihood of reconstructing multiple arteries was similar in all graft types, 27.3% in right and 25% and 21.4% in left lobe and left lateral segments, respectively (p > 0.05). There was no difference in biliary complications (p = 0.85), hepatic artery thrombosis (p = 0.82), and post-surgical hospital stay (p = 0.38) between the three groups. The presence of multiple arteries or their selective reconstruction did not affect survival (p = 0.73).
CONCLUSIONS
CONCLUSIONS
Multiple arterial inflows are not an uncommon entity and demonstration of good hilar collateralization helps in avoiding unnecessary arterial reconstruction without adverse outcomes.
Identifiants
pubmed: 33877447
doi: 10.1007/s00423-021-02176-y
pii: 10.1007/s00423-021-02176-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1943-1949Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 112(3):337–347
doi: 10.1016/0002-9610(66)90201-7
Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 220(1):50–52
doi: 10.1097/00000658-199407000-00008
Lee KW, Lee S, Oh DK, Na BG, Choi JY, Cho W, Lee S, Kim JM, Choi G, Kwon CHD, Joh JW, Lee SK (2016) Outcome of partial reconstruction of multiple hepatic arteries in pediatric living donor liver transplantation using left liver grafts. Transpl Int. 29(8):890–896
doi: 10.1111/tri.12787
Lee KW, Lee S, Huh J, Cho CW, Lee N, Kim HS, Kim K, Kim JM, Choi GS, Kwon CHD, Joh JW, Lee SK (2016) Outcome of living donor liver transplantation using right liver allografts with multiple arterial supply. Liver Transplant. 22(12):1649–1655
doi: 10.1002/lt.24600
Kawarada Y, Das BC, Taoka H (2000 Dec 18) Anatomy of the hepatic hilar area: the plate system. J Hepatobiliary Pancreat Surg. 7(6):580–586
doi: 10.1007/s005340070007
Strasberg SM, Helton WS (2011) An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy, vol 13. HPB. Blackwell Publishing Ltd, pp 1–14
Uchiyama H, Hashimoto K, Hiroshige S, Harada N, Soejima Y, Nishizaki T et al (2002) Hepatic artery reconstruction in living-donor liver transplantation: a review of its techniques and complications. Surgery 131(1 SUPPL)
Sugawara Y, Tamura S, Kaneko J, Iida T, Mihara M, Makuuchi M, Koshima I, Kokudo N (2011) Single artery reconstruction in left liver transplantation. Surgery. 149(6):841–845
doi: 10.1016/j.surg.2010.11.016
Gunji H, Cho A, Tohma T, Okazumi S, Makino H, Shuto K, Mochizuki R, Matsubara K, Hayano K, Mori C, Murakami G, Ochiai T (2006) The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg. 192(3):276–280
doi: 10.1016/j.amjsurg.2006.01.046
Tohma T, Cho A, Okazumi S, Makino H, Shuto K, Mochiduki R, Matsubara K, Gunji H, Ochiai T (2005) Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology. 237(1):361–365
doi: 10.1148/radiol.2371040919
Koehler RE, Korobkin M, Lewis F (1975) Arteriographic demonstration of collateral arterial supply to the liver after hepatic artery ligation. Radiology. 117(1):49–54
doi: 10.1148/117.1.49
Kikuchi Y, Matuyama R, Hiroshima Y, Murakami T, Bouvet M, Morioka D, Hoffman RM, Endo I (2019) Surgical and histological boundary of the hepatic hilar plate system: basic study relevant to surgery for hilar cholangiocarcinoma regarding the “true” proximal ductal margin. J Hepatobiliary Pancreat Sci. 26(5):159–168
doi: 10.1002/jhbp.617
Hayashi S, Murakami G, Ohtsuka A, Itoh M, Nakano T, Fukuzawa Y (2008) Connective tissue configuration in the human liver hilar region with special reference to the liver capsule and vascular sheath. J Hepatobiliary Pancreat Surg. 15(6):640–647
doi: 10.1007/s00534-008-1336-8
Narasimhan G, Safwan M, Kota V, Reddy MS, Bharathan A, Dabora A, Kaliamoorthy I, Kanagavelu RG, Srinivasan V, Rela M (2016) Donor outcomes in living donor liver transplantation-analysis of 275 donors from a single centre in India. Transplantation. 100(6):1251–1256
doi: 10.1097/TP.0000000000001246
Rela M, Heaton ND, Muiesan P, Tan KC (1995) A technique for hepatic artery anastomosis during orthotopic liver transplantation. Transpl Int. 8(3):244–245
doi: 10.1111/j.1432-2277.1995.tb01512.x
Ikegami T, Kawasaki S, Matsunami H, Hashikura Y, Nakazawa Y, Miyagawa S, Furuta S, Iwanaka T, Makuuchi M (1996 Apr 1) Should all hepatic arterial branches be reconstructed in living-related liver transplantation? Surgery. 119(4):431–436
doi: 10.1016/S0039-6060(96)80144-9
Uchiyama H, Harada N, Sanefuji K, Kayashima H, Taketomi A, Soejima Y, Ikegami T, Shimada M, Maehara Y (2010) Dual hepatic artery reconstruction in living donor liver transplantation using a left hepatic graft with 2 hepatic arterial stumps. Surgery. 147(6):878–886
doi: 10.1016/j.surg.2009.06.028
Uchiyama H, Shirabe K, Yoshizumi T, Ikegami T, Soejima Y, Yamashita Y, Kawanaka H, Ikeda T, Morita M, Oki E, Maehara Y (2014) Use of living donor liver grafts with double or triple arteries. Transplantation. 97(11):1172–1177
doi: 10.1097/01.TP.0000442687.33536.c4
Mehta NN, Mangla V, Varma V, Lalwani S, Mehrotra S, Chawla D, Nundy S (2018) Minimizing hepatic artery thrombosis and establishing safety of grafts with dual arteries in living donor liver transplantation. Transplant Proc. 50(5):1378–1385
doi: 10.1016/j.transproceed.2018.02.065
Kim SH, Na BG, Lee EC, Park SJ (2018 Dec) Arterial blood gas test to decide whether to reconstruct single or both the arteries in living donor liver transplantation. HepatoBiliary Surg Nutr. 7(6):440–442
doi: 10.21037/hbsn.2018.10.04
Nakamura T, Tanaka K, Kiuchi T, Kasahara M, Oike F, Ueda M, Kaihara S, Egawa H, Ozden I, Kobayashi N, Uemoto S (2002) Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 73(12):1896–1903
doi: 10.1097/00007890-200206270-00008
Suehiro T, Ninomiya M, Shiotani S, Hiroshige S, Harada N, Ryosuke M, Soejima Y, Shimada M, Sugimachi K (2002) Hepatic artery reconstruction and biliary stricture formation after living donor adult liver transplantation using the left lobe. Liver Transplant. 8(5):495–499
doi: 10.1053/jlts.2002.32986
Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L et al (1991) Liver transplantation in children from living related donors: surgical techniques and results. In: Annals of Surgery. Ann Surg, pp 428–439
Ikegami T, Yoshizumi T, Uchiyama H, Soejima Y, Harada N, Maehara Y (2017) Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow. In: Liver Transplantation, vol 23. John Wiley and Sons Ltd, pp 1081–1082