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Tactics in the management of the variation of the donor hepatic arteries

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Author:
No author available
Journal Title:
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
Issue:
3
DOI:
10.3760/cma.j.issn.0254-1785.2008.03.004
Key Word:
肝移植;肝动脉;血管成形术;Liver transplantation;Hepatic artery;Angioplasty

Abstract: Objective To investigate the variation types and reconstruction menthod of the donor hepatic arteries prior to liver transDlantation.Methods Five hundred and twenty-six cases of liver grafts were harvested with the method of rapid procurement,and the donor hepatic arteries were classified according to Hiatt system.Hepatic artery reconstruction was performed on those with variation of hepatic artery. Spleen artery,gastroduodenal artery or superior mesenteric artery was used for re construction with variant hepatic artery.The reconstruction of hepatic artery before transplantation and anastomosis between donor and recipient artery were both completed under 3.2-3.5 fold magnification.Results Among these donors' hepatic arteries,436 cases were normal(82.6 %,Hiatt Ⅰ),and 92 cases abnormal(17.4 %)accoding to Hiatt system.Thirty-eight cases were classified into Hiatt Ⅱ(7.2 %,38/528),47 cases into Hiatt Ⅲ(8.9 %,47/528),3 cases into Hiatt Ⅳ(0.5 %,3/528),2 cases into Hiatt Ⅴ(0.4 %,2/528)and 2 cases into Hiatt Ⅵ(0.4 %,2/528)respectively.Among 92 cases of hepatic artery variation,53 cases with common originate trunk which can anastomosed to recipient artery directly had no artery reconstruction before transplantation,and the rest 39 cases were subjected to hepatic artery reconstruction prior to liver transplantation:18 cases were subjected to the anastomoses of varian hepatic artery to spleen artery,13 to anastomoses of variant hepatic artery to gastroduodenal artery,and in 8 cases,one end of superior mesenteric artery was anastomosed with donor common hepatic artery(or celiac trunk)for reconstruction,and another end of superior mesenteric artery anastomosed with the choosen recipient artery.Conclusion Hepatic artery variation is frequently encountered.Thus,accurate recognization was essential in liver graft harvesting and back-table procedure to avoid injury.All variant hepatic arteries must be retained for its integrity of liver blood flow,otherwise,it should be reconstructed before liver transplantation.The methods of appropriate reconstruction is dependent on variant type and anatomy of hepatic artery.

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