Microvascular Hepatic Artery Reconstruction in Living Donor Liver Transplantation

Even with the recent technical advances in the surgical procedures used for living donor liver transplantation (LDLT), hepatic artery reconstruction is still one of the most difficult procedures in LDLT (Matsuda et al., 2006; Eguchi et al., 2008). Because hepatic artery complications in liver transplantation, such as hepatic artery thrombosis (HAT) or hepatic artery dissection (HAD), often lead to devastating consequences, such as graft loss or patient death (Yanaga et al., 1990a; Settmacher et al., 2000; Stange et al., 2003), hepatic artery reconstruction should be performed using the most reliable procedure. A graft hepatic artery to be reconstructed in LDLT usually has a narrower caliber and a shorter stump compared to the arteries used during cadaveric liver transplantation. We introduced microvascular surgery for hepatic artery reconstruction in LDLT at the beginning of our LDLT program (Uchiyama et al., 2002). The use of microvascular surgery in LDLT was first reported in 1992 (Mori et al., 1992). Thereafter, many transplant centers introduced this technique for hepatic artery reconstruction in LDLT and confirmed that its application to hepatic artery reconstruction in LDLT decreased the number of hepatic artery complications (Inomoto, et al., 1996; Millis et al., 2000; Wei et al., 2004; Takatsuki et al., 2006; Panossian et al., 2009). We performed 401 cases of LDLT between October 1996 and June 2011 and almost all hepatic artery reconstructions were performed by microvascular surgery under a microscope. Microvascular surgery for hepatic artery reconstruction has been performed by general surgeons in our department. In this chapter, we present our microvascular surgical techniques used for hepatic artery reconstructions in LDLT and the outcomes of these reconstructions in 401 LDLT cases.