Hepatic artery thrombosis (HAT), which is the most common vascular complication after living donor liver transplantation (LDLT), can result in graft loss and devastating consequences. Surgical techniques are suggested to an important factor in causing HAT. Despite improvements in surgical techniques, arterial reconstruction in LDLT has a high risk of thrombosis.
With atraumatic microsurgical techniques, the reconstruction of HA was accomplished in 182 recipients (192 grafts) of adult-to-adult LDLT performed from January 2001 to September 2009 by a settled group of vascular surgeons of a research team from China. Their study will be published on June 7, 2010 in the World Journal of Gastroenterology.
Running sutures with back-wall first techniques were employed in all hepatic arterial reconstruction procedures by a settled group of vascular surgeons with low incidence of HAT. Interposition of great saphenous vein or cryoperserved vessel between recent and graft was performed for handling recipient hepatic arterial dissection with relatively good outcome.
In the authors' view, in order to decrease the incidence of HAT, the principle of hepatic arterial reconstruction will be followed in future clinical procedures, including: a settled group of vascular surgeons, running suture with intimal eversion, sufficient large caliber of stoma and atraumatic manipulation. Running suture may be a reliable alternative for anastomsis of small hepatic artery in diameter with low incidence of HAT following A-A LDLT. Nevertheless, randomized prospective controlled studies should be performed to validate these results.
Reference: Yang Y, Yan LN, Zhao JC, Ma YK, Huang B, Li B, Wen TF, Wang WT, Xu MQ, Yang JY. Microsurgical reconstruction of hepatic artery in A-A LDLT: 124 consecutive cases without HAT. World J Gastroenterol 2010; 16(21): 2682-2688 http://www.
Correspondence to: Lu-Nan Yan, MD, PhD, Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. firstname.lastname@example.org Telephone: +86-28-85422469 Fax: +86-28-85422469
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.