Extra anatomic hepatic artery reconstruction in deceased donor liver transplantation – Feasibility and outcome

BackgroundHepatic arterial inflow to the liver graft following liver transplantation is critical to graft survival. When recipient hepatic artery is not available due to injury or recipient hepatic artery flow is inadequate extra anatomic hepatic arterial reconstruction during deceased donor liver transplantation is required to ensure adequate hepatic arterial blood flow to the graft. The outcome in such patients is analyzed and compared with patient with standard hepatic artery reconstruction.MethodsRetrospective analysis of 30 patients who underwent Deceased Donor Liver Transplantation (DDLT) from March 2007 to May 2010 was done to assess the outcome of extra anatomic arterial inflow reconstruction. DDLT with standard end to end Hepatic Artery anastomosis performed in 24 patients (n = 24) served as control. Extra anatomic hepatic arterial reconstruction (EAHAR) was performed in 6 patients. The preferred choice of EAHAR was to fashion an infrarenal aortic conduit using stored donor iliac artery graft routed through the base of the transverse mesocolon.ResultsExtra anatomic hepatic arterial reconstruction is not associated with increased morbidity, mortality, blood loss, operating room time or thrombosis.ConclusionExtra anatomic hepatic arterial reconstructions are associated with excellent long-term outcomes and provide acceptable alternatives for arterial reconstruction.