Analysis of Outcomes in Living Donor Liver Transplants Involving Reconstructive Microsurgeons

Abstract Background Living donor transplantation is becoming increasingly popular as a modality for patients necessitating liver transplantation. Hepatic artery thrombosis (HAT) remains the most feared acute postoperative complication associated with living-donor liver transplantation. Preoperative planning, including scheduling reconstructive microsurgeons to perform the hepatic artery anastomosis using a surgical microscope or loupes, can decrease HAT rates. Methods A retrospective review of two reconstructive microsurgeons at a single institution was performed to analyze postoperative outcomes of adult and pediatric live donor liver transplants where reconstructive microsurgeons performed the hepatic artery anastomosis. One surgeon utilized the surgical microscope, while the other surgeon opted to use surgical loupes for the anastomosis. Results A total of 38 patients (30 adult and eight pediatric) met inclusion criteria for this study, and average patient age in the adult and pediatric population studied was 48.5 and 3.6 years, respectively. Etiologies of adult patients' liver failure were most commonly cholestatic (43%), followed by alcohol (23%), hepatitis C virus-related cirrhosis (17%), and nonalcoholic steatohepatitis (7%), while etiologies of pediatric liver failure were most commonly cholestatic (62.5%). None of the patients (0%) experienced acute postoperative HAT. On average, 22 and 25 months of postoperative follow-up was obtained for the adult and pediatric cohorts, respectively, and only one adult patient was found to have any liver-related complication. Conclusion A collaborative relationship between reconstructive microsurgeons and transplant surgeons mitigates the risk of HAT and improves patient outcomes in living donor liver transplantation.

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EXTRA-ANATOMICAL HEPATIC ARTERY RECONSTRUCTION IN LIVING DONOR LIVER TRANSPLANTATION: LESSONS FROM 352 LIVER TRANSPLANTS.

Transplantation Journal ◽

10.1097/00007890-201007272-00653 ◽

2010 ◽

Vol 90 ◽

pp. 349

Author(s):

H. Uchiyama ◽

K. Shirabe ◽

A. Taketomi ◽

Y. Soejima ◽

T. Yoshizumi ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Artery ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Liver Transplants ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Hepatic Artery Reconstruction ◽

Artery Reconstruction

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Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽

10.1024/1023-9332.9.5.227 ◽

2003 ◽

Vol 9 (5) ◽

pp. 227-236 ◽

Cited By ~ 3

Author(s):

Majno ◽

Mentha ◽

Berney ◽

Bühler ◽

Giostra ◽

...

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Therapeutic Option ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Multidisciplinary Program ◽

First Case ◽

Living Donor Transplantation ◽

The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

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Faculty Opinions recommendation of Pediatric acute liver failure in Brazil: Is living donor liver transplantation the best choice for treatment?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726238329.793517247 ◽

2016 ◽

Author(s):

Lorenzo D'Antiga

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Pediatric Acute Liver Failure

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Early graft calcification without graft dysfunction after living donor liver transplantation: two case reports

Clinical Journal of Gastroenterology ◽

10.1007/s12328-021-01471-x ◽

2021 ◽

Vol 14 (5) ◽

pp. 1491-1495

Author(s):

Peilin Li ◽

Masaaki Hidaka ◽

Yu Huang ◽

Takanobu Hara ◽

Kantoku Nagakawa ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Artery ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Liver Graft ◽

Graft Dysfunction ◽

Donor Liver ◽

Donor Liver Transplantation ◽

First Case ◽

Post Operation

AbstractGraft calcification after liver transplantation (LT) has seldom been reported, but almost of all previously reported cases have been attributed to graft dysfunction. We herein report two cases of graft calcification without liver dysfunction after living donor liver transplantation (LDLT). Two patients who underwent LDLT were found to have graft calcification in the early postoperative period (< 1 month). Calcification in the first case was found at the cut edge of the liver at post-operative day (POD) 10, showing a time-dependent increase in calcification severity. The second patient underwent hepatic artery re-anastomosis due to hepatic artery thrombosis on POD4 and received balloon-occluded retrograde transvenous obliteration of the splenic kidney shunt due to decreased portal vein blood flow on POD6. She was found to have diffuse hepatic calcification in the distant hepatic artery area at 1-month post-operation followed by gradual graft calcification at the resection margin at 6-month post-operation. Neither case showed post-operative graft dysfunction. Calcification of the liver graft after LDLT is likely rare, and graft calcification does not seem to affect the short-term liver function in LDLT cases. We recommend strictly controlling the warm/cold ischemia time and reducing the physical damage to the donor specimen as well as monitoring for early calcification by computed tomography.

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