ABSTRACT
Introduction: Hepatic artery reconstruction is a critical aspect of liver transplantation. The microsurgeon
faces several challenges when reconstructing the hepatic artery—the donor hepatic artery stalk is short
and often a poor match for the usually hypertrophic recipient vessels. Previous inflammation impedes
vessel dissection, and recipient vessels have a tendency to delaminate with manipulation. We review 51
consecutive liver transplantations to highlight these problems and propose strategies for a successful
reconstruction of the hepatic artery.
Methods: A prospective study involving all adult patients undergoing liver transplantation at the
Singapore General Hospital from January 2015 to December 2018 was undertaken. All hepatic artery
anastomoses were performed by 2 microsurgeons at 10x magnification. Patients were started on a
standard immunosuppressive regimen. Postoperative ultrasound scans on days 1, 3, 5, 7, 9 and 14
were used to confirm arterial patency.
Results: There were 51 patients who underwent liver transplantation during the study period. Of this
number, 31 patients received deceased donor grafts and 20 received living donor grafts. A total of 61
anastomoses were performed (5 dual anastomosis, 4 radial artery interposition grafts) with 1 case of
hepatic artery thrombosis that was successfully salvaged. The mean (range) postoperative resistive
index and hepatic artery peak systolic velocity were 0.69 (0.68–0.69) and 1.0m/s (0.88–1.10m/s),
respectively.
Conclusion: Hepatic artery thrombosis after liver transplantation is poorly tolerated. The challenges
of hepatic artery reconstruction in liver transplantation are related to vessel quality and length. The use
of microsurgical technique, appropriate recipient vessel selection, minimisation of vessel manipulation
with modified instruments, variation in anastomosis techniques, and use of radial artery interpositional
grafts are useful strategies to maximise the chances of success.
Keywords: Hepatic artery, hepatology, liver transplant, microsurgery, plastic surgery
Hepatic artery reconstruction using an operating microscope in pediatric liver transplantation—Is it worth the effort?
