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Impact of middle hepatic artery reconstruction after living donor liver transplantation using the left lobe
Author(s) -
Harada Noboru,
Yoshizumi Tomoharu,
Uchiyama Hideaki,
Ikegami Toru,
Itoh Shinji,
Takeishi Kazuki,
Toshima Takeo,
Nagao Yoshihiro,
Yoshiya Shohei,
Mori Masaki
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13850
Subject(s) - medicine , anastomosis , artery , liver transplantation , left hepatic duct , bile duct , living donor liver transplantation , surgery , biliary tract , gauche effect , transplantation , common hepatic artery , surgical anastomosis , radiology
The aim of this study was to clarify the impact of middle hepatic artery reconstruction on the outcomes of duct‐to‐duct biliary anastomosis after living donor liver transplantation (LDLT) using the left lobe. Materials and Methods Among 258 patients who underwent LDLT using the left lobe, 216 patients who underwent hepatic artery reconstruction and one hepatic duct reconstruction with duct‐to‐duct interrupted anastomosis were divided into three groups: Group A (n = 123), one arterial stump with left hepatic artery reconstruction; Group B (n = 32), two arterial stumps with only left hepatic artery reconstruction; and Group C (n = 61), two arterial stumps with reconstruction of the left and middle hepatic arteries. The outcomes after LDLT were compared among the three groups. Results No hepatic artery complications occurred. Group B had a significantly greater incidence of anastomotic biliary stricture than Group C. A multivariate analysis with Cox regression revealed that being in Group B was the only significant independent risk factor for postoperative anastomotic biliary stricture after LDLT. Conclusions Middle and left hepatic artery reconstruction is safe in LDLT and may prevent biliary stricture caused by dual hepatic artery reconstruction when the graft has left and middle hepatic artery stumps.