Skip to main content

Advertisement

SpringerLink
Log in

Reconstructing single hepatic artery with two arterial stumps: biliary complications in pediatric living donor liver transplantation

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Introduction

Liver grafts can at times have two hepatic arterial stumps. This can result in a dilemma whether to reconstruct single or both the arteries. Hepatic artery (HA) thrombosis is the most dreaded complication in pediatric living donor liver transplantation (LDLT) as it can result in biliary complications and subsequent graft loss. We herein report the feasibility of reconstructing single hepatic artery in pediatric living donor liver transplantation having two arterial stumps in the liver graft.

Materials and methods

From 2008 to 2010, 87 pediatric patients undergoing LDLT were divided into three groups. Group 1 (n = 20): two HA stumps with two HA reconstruction, Group 2 (n = 22): two HA stumps with one HA reconstruction and Group 3 (n = 45): one HA stump with one HA reconstruction. The decision regarding the reconstruction of single or multiple HAs was made depending on the pre-operative radiological and intraoperative assessments.

Results

The incidence of HA thrombosis (p = 0.126) and biliary complications (p = 0.617), was similar in the three groups.

Conclusion

Single HA reconstruction does not increase the risk of biliary strictures in pediatric LDLT recipients having dual hepatic arterial stumps in the liver graft.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

LDLT:

Living donor liver transplantation

HA:

Hepatic artery

PELD:

Pediatric end-stage lived disease

HAT:

Hepatic artery thrombosis

CTA:

Computed tomography angiography

MRA:

Magnetic resonance angiography

DUS:

Doppler ultrasound

References

  1. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido U, Balderson GA (1990) Successful liver transplantation from a living donor to her son. N Engl J Med 322:1505–1507

    Article  CAS  Google Scholar 

  2. Broelsch CE, Emond JC, Whitington PF, Thistelethwaite JR, Baker AL, Lichtor JL (1990) Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg 212:368–375

    Article  CAS  PubMed  Google Scholar 

  3. Otte JB, de Ville de Goyet J et al (1990) Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organ in pediatric liver transplantation. Ann Surg 211:146–157

    Article  CAS  PubMed  Google Scholar 

  4. Broelsch CE, Whitington PF, Emond JC (1991) Liver transplantation in children from living related donor. Ann Surg 214:428–439

    Article  CAS  PubMed  Google Scholar 

  5. Ozawa K, Uemoto S, Tanaka K (1992) An appraisal of pediatric liver transplantation from living relatives. Ann Surg 216:547–553

    Article  CAS  PubMed  Google Scholar 

  6. Ackermanna O, Branchereau S, Franchi-Abella S et al (2012) The long-term outcome of hepatic artery thrombosis after liver transplantation in children: role of urgent revascularization. Am J Transpl 12:1496–1503

    Article  Google Scholar 

  7. Bekker J, Ploem S, de Jong KP et al (2009) Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transpl 9:746–757

    Article  CAS  Google Scholar 

  8. Krishna Kumar G, Sharif K, Mayer D, Mirza D et al (2010) Hepatic venous outflow obstruction in pediatric liver transplantation. Pediatr Surg Int 26:423–425

    Article  CAS  PubMed  Google Scholar 

  9. Soin AS, Kumaran V, Rastogi AN et al (2010) Evolution of reliable biliary reconstructive technique in 400 consecutive living donor liver transplants. J Am Coll Surg 211:24–32

    Article  PubMed  Google Scholar 

  10. Inomoto T, Nishizawa F, Sasaki H (1996) Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation. Surgery 119:20–26

    Article  CAS  PubMed  Google Scholar 

  11. Kotestelic JK, Piper JB, Leef JA et al (1996) Angiographic selection criteria for living related liver transplant donors. Am J Roentgenol 166:1103–1108

    Article  Google Scholar 

  12. Kubota K, Makuuchi M, Takayama T et al (2000) Simple test on the back table for justifying single hepatic-artery reconstruction in living related liver transplantation. Transplantation 70:696–697

    Article  CAS  PubMed  Google Scholar 

  13. Suehiro T, Ninomiya M, Shiotani S et al (2002) Hepatic artery reconstruction and BS formation after living donor adult liver transplantation using the left lobe. Liver Transpl 8:495–499

    Article  PubMed  Google Scholar 

  14. Ikegami T, Kawasaki S, Matsunami H et al (1996) Should all hepatic arterial branches be reconstructed in living-related liver transplantation? Surgery 119:431–436

    Article  CAS  PubMed  Google Scholar 

  15. Chen CL, Concejero A, Wang CC et al (2006) Living donor liver transplantation for biliary atresia: a single-center experience with first 100 cases. Am J Transpl 6:2672–2679

    Article  Google Scholar 

  16. De Villa VH, Chen CL, Chen YS et al (2000) Outflow tract reconstruction in living donor liver transplantation. Transplantation 70:1604–1608

    Article  PubMed  Google Scholar 

  17. Chen CL, Chen YS, De Villa VH et al (2000) Minimal blood loss living donor hepatectomy. Transplantation 69:2580–2586

    Article  CAS  PubMed  Google Scholar 

  18. Takatsuki M, Chiang YC, Lin TS (2006) Anatomical and technical aspects of hepatic artery reconstruction in living donor liver transplantation. Surgery 140:824–828

    Article  PubMed  Google Scholar 

  19. Kasahara M, Egawa H, Takada Y et al (2006) Biliary reconstruction in right lobe living-donor liver transplantation: comparison of different techniques in 321 recipients. Ann Surg 243:559–566

    Article  PubMed  Google Scholar 

  20. Uchiyama H, Harada N, Sanefuji K et al (2010) Dual hepatic artery reconstruction in living donor liver transplantation using a left hepatic graft with two hepatic arterial stumps. Surgery 147:878–886

    Article  PubMed  Google Scholar 

  21. Sugawara Y, Tamura S, Kaneko J et al (2011) Single artery reconstruction in left liver transplantation. Surgery 149:841–845

    Article  PubMed  Google Scholar 

  22. Farmer DG, Venick RS, McDiarmid SV et al (2007) Predictors of outcomes after pediatric liver transplantation: an analysis of more than 800 cases performed at a single institution. J Am Coll Surg 204:904–906

    Article  PubMed  Google Scholar 

  23. Alexopoulos SP, Merrill M, Kin C et al (2012) The impact of hepatic portoenterostomy on liver transplantation for the treatment of biliary atresia: early failure adversely affects outcome. Pediatr Transpl 16:373–378

    Article  Google Scholar 

  24. Mori K, Nagata I, Yamagata S (1992) The introduction of microvascular surgery to hepatic artery reconstruction in living-donor liver transplantation. Transplantation 54:263–268

    Article  CAS  PubMed  Google Scholar 

  25. Egawa H, Inomata Y, Uemoto S et al (2001) Biliary anastomotic complications in 400 living related liver transplantation. World J Surg 25:1300–1307

    Article  CAS  PubMed  Google Scholar 

  26. Chok KS, Chan SC, Cheung TT, Sharr WW, Chan AC, Lo CM (2011) Bile duct anastomotic stricture after adult-to-adult right lobe living donor liver transplantation. Liver Transpl 17:47–52

    Article  PubMed  Google Scholar 

  27. Hwang S, Lee SG, Sung KB et al (2006) Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. Liver Transpl 12:831

    Article  PubMed  Google Scholar 

  28. Dacha S, Barad A, Matin J, Levitsky J (2011) Association of hepatic artery stenosis and biliary strictures in liver transplant recipients. Liver Transpl 17:849

    Article  PubMed  Google Scholar 

  29. Sundaram V, Jones DT, Shah NH et al (2011) Post-transplant biliary complications in the pre- and post-model for end-stage liver disease era. Liver Transpl 17:428

    Article  PubMed  Google Scholar 

  30. Verdonk RC, Buis CI, Porte RJ et al (2006) Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 12:726

    Article  PubMed  Google Scholar 

  31. Welling TH, Heidt DG, Englesbe MJ et al (2008) Biliary complications following liver transplantation in the model for end-stage liver disease era: effect of donor, recipient and technical factors. Liver Transpl 14:73

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan

    Karan D. Julka, Tsan-Shiun Lin, Chao-Long Chen, Chih-Chi Wang & Andrzej L. Komorowski

Authors
  1. Karan D. Julka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsan-Shiun Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chao-Long Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chih-Chi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrzej L. Komorowski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karan D. Julka.

Additional information

K. D. Julka and T.-S. Lin have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Julka, K.D., Lin, TS., Chen, CL. et al. Reconstructing single hepatic artery with two arterial stumps: biliary complications in pediatric living donor liver transplantation. Pediatr Surg Int 30, 39–46 (2014). https://doi.org/10.1007/s00383-013-3436-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-013-3436-z

Keywords

Search

Navigation