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Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques
Author(s) -
Mabrouk Mourad Moustafa,
Liossis Christos,
Kumar Senthil,
Gunson Bridget K.,
Mergental Hynek,
Isaac John,
Bramhall Simon R.,
Muiesan Paolo,
Mirza Darius F.,
Thamara P. R. Perera M.
Publication year - 2015
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24015
Subject(s) - medicine , liver transplantation , perspective (graphical) , lobe , transplantation , surgery , radiology , general surgery , anatomy , artificial intelligence , computer science
Split liver transplantation (SLT) compensates for the organ shortage and provides an alternative solution for recipients disadvantaged by a smaller body size. Variations in the hepatic arterial anatomy and reconstructive techniques may lead to more technical complications, and we sought to analyze the incidence and risk factors of vasculobiliary complications with respect to reconstructive techniques. We identified 171 adult right lobe SLT procedures and 1412 whole liver transplantation (WLT) procedures between January 2000 and June 2012 and compared the results of these 2 groups. In the SLT group, arterial reconstruction techniques were classified into 4 subgroups (I‐IV), and biliary reconstruction was classified into 2 groups [duct‐to‐duct (DD) anastomosis and Roux‐en‐Y hepaticojejunostomy (RH)]. Specific surgical complications were analyzed against reconstruction techniques. The overall incidence of vascular and biliary complications in the SLT group was greater than that in the WLT group ( P = 0.009 and P = 0.001, respectively). There was no difference in hepatic artery thrombosis (HAT), but we saw a tendency toward early HAT in the presence of multiple hepatic arteries supplying the right lobe graft (group IV; 20%) in comparison with the other arterial reconstruction groups ( P = 0.052). No difference was noticed in the overall incidence of biliary complications in either DD or RH recipients across 4 arterial reconstruction groups. When the arterial reconstruction involved a right hepatic artery (groups II and III) combined with a DD biliary anastomosis, there was a significant preponderance of biliary complications ( P = 0.04 and P = 0.01, respectively). There was no survival difference between SLT and WLT grafts. In conclusion, the complications of SLT are directly related to arterial and biliary reconstruction techniques, and this classification helps to identify high‐risk reconstructive techniques. Liver Transpl 21:63‐71, 2015 . © 2014 AASLD.