Introduction. The incidence of left hepatic arteries with aberrant origin (from left gastric artery, aorta, splenic artery, celiac trunk, etc.) in donors is about 35%. The reconstruction of these arteries at liver transplantation (LT) can ensure the proper vascularization of the left liver but can also be a risk factor for hepatic artery thrombosis. We retrospectively analyzed the postoperative impact of the intraoperative ligation of aberrant left hepatic arteries of the graft vs preservation of aberrant left hepatic arteries after LT. Materials and methods. From 8-2005 to 4-2014 we performed 319 liver transplants. In 87 (27.3%) grafts there were abnormalities of the arterial vascularization. In 51 (16%) grafts there was an aberrant right hepatic artery (49 arising from the superior mesenteric artery, 1 from superior mesenteric artery, 1 from celiac trunk). In 46 (14.4%) grafts there was an accessory left hepatic artery (42 from left hepatic artery, 2 from celiac trunk, 2 from the aorta), in 4 graft the common hepatic artery arises from superior mesenteric artery (hepato-mesenteric trunk). Results. In 18/46 (39.1%) patients the accessory left hepatic artery was intraoperatively ligated (LHAL Group), while in 28/46 (60.9%) patients the aberrant left hepatic artery was preserved (LHAP Group) using the celiac trunk of the graft or with an anastomosis with the gastroduodenal artery of the graft. 1-3 years graft survival was 89.3-89.3% in LHAL Group vs. 85.6-85.6% in LHAP Group (p=0.45).After a mean follow-up of 40.7±31.9 months, 1 (5.5%) late hepatic artery thrombosis occurred in LHAL group, while 2 (7.1%) hepatic artery thrombosis (one early and one late) occurred in the LHAP group (p=1). In LHAL group 3 (16.7%) anastomotic biliary strictures occurred vs 10 (35.7%) in the LHAP group (p=0.20). Conclusion. Intraoperative left hepatic artery ligation does not provide an increased risk of hepatic artery thrombisis or biliary complications after LT.
IMPACT OF ABERRANT LEFT HEPATIC ARTERY LIGATION ON OUTCOME AFTER LIVER TRANSPLANTATION / Montalti, Roberto; Mocchegiani, Federico; Pansini, Mauro; Nicolini, Daniele; Vecchi, Andrea; Vincenzi, Paolo; Vivarelli, Marco. - (2015). (Intervento presentato al convegno • 17th Congress of the European Society for Organ Transplantation (ESOT) From the heart of Europe to the world of transplantation tenutosi a Brussels, Belgium. nel 13-16 September 2015).
IMPACT OF ABERRANT LEFT HEPATIC ARTERY LIGATION ON OUTCOME AFTER LIVER TRANSPLANTATION
Roberto Montalti
;
2015
Abstract
Introduction. The incidence of left hepatic arteries with aberrant origin (from left gastric artery, aorta, splenic artery, celiac trunk, etc.) in donors is about 35%. The reconstruction of these arteries at liver transplantation (LT) can ensure the proper vascularization of the left liver but can also be a risk factor for hepatic artery thrombosis. We retrospectively analyzed the postoperative impact of the intraoperative ligation of aberrant left hepatic arteries of the graft vs preservation of aberrant left hepatic arteries after LT. Materials and methods. From 8-2005 to 4-2014 we performed 319 liver transplants. In 87 (27.3%) grafts there were abnormalities of the arterial vascularization. In 51 (16%) grafts there was an aberrant right hepatic artery (49 arising from the superior mesenteric artery, 1 from superior mesenteric artery, 1 from celiac trunk). In 46 (14.4%) grafts there was an accessory left hepatic artery (42 from left hepatic artery, 2 from celiac trunk, 2 from the aorta), in 4 graft the common hepatic artery arises from superior mesenteric artery (hepato-mesenteric trunk). Results. In 18/46 (39.1%) patients the accessory left hepatic artery was intraoperatively ligated (LHAL Group), while in 28/46 (60.9%) patients the aberrant left hepatic artery was preserved (LHAP Group) using the celiac trunk of the graft or with an anastomosis with the gastroduodenal artery of the graft. 1-3 years graft survival was 89.3-89.3% in LHAL Group vs. 85.6-85.6% in LHAP Group (p=0.45).After a mean follow-up of 40.7±31.9 months, 1 (5.5%) late hepatic artery thrombosis occurred in LHAL group, while 2 (7.1%) hepatic artery thrombosis (one early and one late) occurred in the LHAP group (p=1). In LHAL group 3 (16.7%) anastomotic biliary strictures occurred vs 10 (35.7%) in the LHAP group (p=0.20). Conclusion. Intraoperative left hepatic artery ligation does not provide an increased risk of hepatic artery thrombisis or biliary complications after LT.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
