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Outcomes of Microsurgical Hepatic Artery Anastomosis in Liver Transplantation: A Series of 159 Consecutive Cases
Danielle Sim
*, Waldemar Rodriguez-Silva, Shanmuga Priya Rajagopalan, Amy van Ee, Siam Rezwan, Jeffrey Khong, Hafsa Sulaiman, Elizabeth King, Andrew Cameron, Carisa Cooney, Damon Cooney
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Background: Microsurgical hepatic artery anastomosis in liver transplantation has been shown to decrease post-operative complications including hepatic artery thrombosis (HAT). However, outcomes of this procedure are not well characterized in the United States. This study aims to describe outcomes following liver transplantation with microsurgical hepatic artery anastomosis.
Methods: We conducted a retrospective case series of all patients who underwent deceased or living donor liver transplantation with microsurgical hepatic artery anastomosis at a single institution from January 2008 to October 2023. Demographics, surgical details, and post-operative complications were collected. The primary outcome was HAT within 30 days. Secondary outcomes included HAT management and graft and patient survival.
Results: A total of 159 patients were included; 120 (75%) were adults. Living donor liver transplantation (LDLT) was most often performed (adults: n=117, 98%; pediatric patients: n=25, 64%). Microscopic magnification was used to assist with hepatic artery anastomosis in 127 (80%) patients. Twelve (10%) adults and one (2.5%) child developed HAT with 12 patients requiring surgical intervention. Among these patients, 7 (58%) returned to the OR with microsurgeons resulting in 1 (14%) graft loss and 5 (42%) returned to the OR without microsurgical involvement resulting in 3 (60%) graft losses. Median (interquartile range) follow-up length was 28 (13-65) months; 1-year graft and patient survival rates were 92% and 95%, respectively.
Conclusion: Our findings indicate that microsurgical hepatic artery anastomosis in liver transplantation is a safe procedure and may lower risk of hepatic artery complications in LDLT, especially for pediatric patients. Timely microsurgical intervention for HAT may also be effective in salvaging grafts. Further studies are needed to identify risk factors for HAT following the use of microsurgical techniques in liver transplantation.
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