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Pediatric Surgery International

Published in:

01-12-2023 | Liver Transplantation | Original Article

Microsurgical replacement of the right hepatic artery with the donor superior mesenteric artery in cadaveric donor pediatric liver transplantation

Authors: Zhiwei Li, Wei Zhang, Yan Shen, Xueli Bai, Tingbo Liang

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Purpose

To present our experience of using the pediatric donor superior mesenteric artery (SMA) as the interpositioning vessel to reconstruct the hepatic artery in pediatric deceased donor liver transplantation.

Methods

Pediatric patients who received pediatric deceased donor livers from December 2019 to June 2021 were enrolled.

Results

A total of 43 pediatric recipients received pediatric deceased donor livers during the study period. Thirty-four (79.1%) pediatric donors had normal hepatic artery anatomy, while nine (20.9%) showed variant anatomies. The SMAs of the pediatric donors were interposed in the latter eight cases. The anastomosis between the donor distal SMA and the donor celiac trunk artery (CTA) was initially performed in the back-table period, after which the other anastomosis between the donor proximal SMA and recipient CHA was performed. Only one case showed HAT occurrence (incidence rate, 2.3%). However, no arterial complications occurred in pediatric recipients with donor grafts that showed the variation of RHA replacement from the SMA and had undergone usage of the donor’s SMA as an interpositioning vessel.

Conclusions

In pediatric deceased donor liver transplantation, the use of SMA as an interpositioning medium can solve the problems related to a tiny caliber and anatomical variations of the donor hepatic artery.

Martinelli J, Habes D, Majed L, Guettier C, Gonzales E, Linglart A, Larue C, Furlan V, Pariente D, Baujard C, Branchereau S, Gauthier F, Jacquemin E, Bernard O (2018) Long-term outcome of liver transplantation in childhood: A study of 20-year survivors. Am J Transplant 18(7):1680–1689. https://doi.org/10.1111/ajt.14626CrossRefPubMed

Ma N, Song Z, Dong C, Sun C, Meng X, Zhang W, Wang K, Wu B, Li S, Qin H, Han C, Li H, Gao W, Shen Z (2019) Risk factors of hepatic artery thrombosis in pediatric deceased donor liver transplantation. Pediatr Surg Int 35(8):853–859. https://doi.org/10.1007/s00383-019-04500-6CrossRefPubMed

Bekker J, Ploem S, de Jong KP (2009) Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 9(4):746–757. https://doi.org/10.1111/j.1600-6143.2008.02541.xCrossRefPubMed

Chen CL, Concejero A, Wang CC, Wang SH, Lin CC, Liu YW, Yong CC, Yang CH, Lin TS, Chiang YC, Jawan B, Huang TL, Cheng YF, Eng HL (2006) Living donor liver transplantation for biliary atresia: a single-center experience with first 100 cases. Am J Transplant 6(11):2672–2679. https://doi.org/10.1111/j.1600-6143.2006.01528.xCrossRefPubMed

Jain A, Costa G, Marsh W, Fontes P, Devera M, Mazariegos G, Reyes J, Patel K, Mohanka R, Gadomski M, Fung J, Marcos A (2006) Thrombotic and nonthrombotic hepatic artery complications in adults and children following primary liver transplantation with long-term follow-up in 1000 consecutive patients. Transpl Int 19(1):27–37. https://doi.org/10.1111/j.1432-2277.2005.00224.xCrossRefPubMed

Silva MA, Jambulingam PS, Gunson BK, Mayer D, Buckels JA, Mirza DF, Bramhall SR (2006) Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom. Liver Transpl 12(1):146–151. https://doi.org/10.1002/lt.20566CrossRefPubMed

Shirouzu Y, Kasahara M, Morioka D, Sakamoto S, Taira K, Uryuhara K, Ogawa K, Takada Y, Egawa H, Tanaka K (2006) Vascular reconstruction and complications in living donor liver transplantation in infants weighing less than 6 kilograms: the Kyoto experience. Liver Transpl 12(8):1224–1232. https://doi.org/10.1002/lt.20800CrossRefPubMed

Melada E, Maggi U, Rossi G, Caccamo L, Gatti S, Paone G, Reggiani P, Brigati E, Fassati LR (2005) Back-table arterial reconstructions in liver transplantation: single-center experience. Transplant Proc 37(6):2587–2588. https://doi.org/10.1016/j.transproceed.2005.06.058CrossRefPubMed

Winston CB, Lee NA, Jarnagin WR, Teitcher J, DeMatteo RP, Fong Y, Blumgart LH (2007) CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol 189(1):W13–W19. https://doi.org/10.2214/AJR.04.1374CrossRefPubMed

10.

Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112(3):337–347. https://doi.org/10.1016/0002-9610(66)90201-7CrossRefPubMed

11.

Warnaar N, Polak WG, de Jong KP, de Boer MT, Verkade HJ, Sieders E, Peeters PM, Porte RJ (2010) Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation. Liver Transpl 16(7):847–855. https://doi.org/10.1002/lt.22063CrossRefPubMed

12.

Abouljoud MS, Kim DY, Yoshida A, Arenas J, Jerius J, Malinzak L, Raoufi M, Brown KA, Moonka DK (2005) Impact of aberrant arterial anatomy and location of anastomosis on technical outcomes after liver transplantation. J Gastrointest Surg 9(5):672–678. https://doi.org/10.1016/j.gassur.2005.01.002CrossRefPubMed

13.

Cherian PT, Hegab B, Oliff SP, Wigmore SJ (2010) The management of an accessory or replaced right hepatic artery during multiorgan retrieval: results of an angiographic study. Liver Transpl 16(6):742–747. https://doi.org/10.1002/lt.22075CrossRefPubMed

14.

Di Benedetto F, Cautero N, De Ruvo N, Masetti M, Montalti R, Gerunda GE, Quintini C (2006) A new reconstruction of the accessory donor right hepatic artery with interposition of the SMA in liver transplantation. Surgery 140(5):835. https://doi.org/10.1016/j.surg.2006.03.010CrossRefPubMed

15.

Tsaroucha A, Webb M, Karatzas T, Dickson P, Demirbas A, Fragulidis G, Nery J, Khan F, Tzakis A (1997) Management of allograft-replaced right hepatic arteries in liver transplantation: a review of the University of Miami experience and a preferred method of reconstruction. Transplant Proc 29(7):2856–2858. https://doi.org/10.1016/s0041-1345(97)00707-0CrossRefPubMed

16.

Soin AS, Friend PJ, Rasmussen A, Saxena R, Tokat Y, Alexander GJ, Jamieson NV, Calne RY (1996) Donor arterial variations in liver transplantation: management and outcome of 527 consecutive grafts. Br J Surg 83(5):637–641. https://doi.org/10.1002/bjs.1800830515CrossRefPubMed

17.

Chen X, Wei L, Zhu Z, Sun L, Qu W, Zeng Z (2019) Hepatic artery reconstruction with interposition of donor’s right gastroepiploic artery graft in pediatric living donor liver transplantation for metabolic disease. Pediatr Transplant 23(4):e13418. https://doi.org/10.1111/petr.13418CrossRefPubMed

Title: Microsurgical replacement of the right hepatic artery with the donor superior mesenteric artery in cadaveric donor pediatric liver transplantation
Authors: Zhiwei Li
Wei Zhang
Yan Shen
Xueli Bai
Tingbo Liang
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Thrombosis
Liver Transplantation
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05281-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Microsurgical replacement of the right hepatic artery with the donor superior mesenteric artery in cadaveric donor pediatric liver transplantation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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