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Berg T, Aehling NF, Bruns T, Welker MW, Weismüller T, Trebicka J, Tacke F, Strnad P, Sterneck M, Settmacher U, Seehofer D, Schott E, Schnitzbauer AA, Schmidt HH, Schlitt HJ, Pratschke J, Pascher A, Neumann U, Manekeller S, Lammert F, Klein I, Kirchner G, Guba M, Glanemann M, Engelmann C, Canbay AE, Braun F, Berg CP, Bechstein WO, Becker T, Trautwein C. S2k-Leitlinie Lebertransplantation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1397-1573. [PMID: 39250961 DOI: 10.1055/a-2255-7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Thomas Berg
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Niklas F Aehling
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Tony Bruns
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martin-Walter Welker
- Medizinische Klinik I Gastroent., Hepat., Pneum., Endokrin. Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Tobias Weismüller
- Klinik für Innere Medizin - Gastroenterologie und Hepatologie, Vivantes Humboldt-Klinikum, Berlin, Deutschland
| | - Jonel Trebicka
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Frank Tacke
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Pavel Strnad
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martina Sterneck
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Seehofer
- Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Eckart Schott
- Klinik für Innere Medizin II - Gastroenterologie, Hepatologie und Diabetolgie, Helios Klinikum Emil von Behring, Berlin, Deutschland
| | | | - Hartmut H Schmidt
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Hans J Schlitt
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Johann Pratschke
- Chirurgische Klinik, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Andreas Pascher
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Ulf Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Steffen Manekeller
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Frank Lammert
- Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Ingo Klein
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Kirchner
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg und Innere Medizin I, Caritaskrankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - Markus Guba
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München, Deutschland
| | - Matthias Glanemann
- Klinik für Allgemeine, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Cornelius Engelmann
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Ali E Canbay
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - Felix Braun
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
| | - Christoph P Berg
- Innere Medizin I Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolf O Bechstein
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Thomas Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
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Rastogi A, Gupta AA, Piplani T, Yadav KS, K V F, Bhangui P, Soin AS. Hilar Anatomy in 3035 Living Liver Donors: A Novel Classification for Donor Surgery and Suitability, Hepatic Surgeries, and Hepatobiliary Interventions. Transplantation 2024; 108:455-463. [PMID: 37953482 DOI: 10.1097/tp.0000000000004807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND This study examines the vascular and biliary variations in 3035 liver donors. We propose a novel classification of hepatic arteries, portal veins, and bile ducts and clinically relevant donor classification. METHODS Preoperative imaging and operative details of 3035 donors from 2005 to 2020 were reviewed. Hilar anatomical variations were identified and grouped on the basis of incidence and clinical relevance. RESULTS Hilar structures are classified according to the numbers supplying or draining the graft: for the hepatic artery, right (R) and left (L), RA1/LA1 (1 artery), RA2/LA2 (2 arteries), and RA3/LA3 (3 arteries), respectively, further defined on the basis of the inflow trunk into C (for common hepatic artery), S (for superior mesenteric artery), and L (for left gastric artery); for the portal vein, RP1 (1 vein) and RP2 (2 veins) for the right lobe; and for the hepatic duct, RB1/LB1 (1 duct), RB2/LB2 (2 ducts), RB3 (3 right ducts), and RB4 (4 right ducts). Donors were classified on the basis of anatomical variations into 3 groups: class 1 and class 2 donors, who can donate liver with acceptable risks, and class 3 donors, who are high-risk donors because they are anatomically unacceptable ( Figures S1 to S4, SDC , http://links.lww.com/TP/C918 ). CONCLUSIONS Defining hilar anatomical variations and donor grouping into anatomy-based clinical classes helps in operative planning of donors, hepatobiliary surgeries, and interventional procedures.
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Affiliation(s)
- Amit Rastogi
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Ankur A Gupta
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Tarun Piplani
- Division of Liver and GI Radiology, Institute of Radiology, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Kamal S Yadav
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Fysal K V
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Prashant Bhangui
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Arvinder S Soin
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
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Yim SH, Min EK, Choi MC, Kim DG, Han DH, Joo DJ, Choi JS, Kim MS, Choi GH, Lee JG. Unusual grafts for living-donor liver transplantation. Eur J Med Res 2023; 28:454. [PMID: 37875961 PMCID: PMC10594742 DOI: 10.1186/s40001-023-01428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE Unusual grafts, including extended left liver plus caudate lobe, right anterior section, and right posterior section grafts, are alternatives to left and right lobe grafts for living-donor liver transplantation. This study aimed to investigate unusual grafts from the perspectives of recipients and donors. METHODS From 2016 to 2021, 497 patients received living-donor liver transplantation at Severance Hospital. Among them, 10 patients received unusual grafts. Three patients received extended left liver plus caudate lobe grafts, two patients received right anterior section grafts, and five patients received right posterior section grafts. Liver volumetrics and anatomy were analyzed for all recipients and donors. We collected data on laboratory examinations (alanine aminotransferase, total bilirubin, international normalized ratio), imaging studies, graft survival, and complications. A 1:2 ratio propensity-score matching method was used to reduce selection bias and balance variables between the unusual and conventional graft groups. RESULTS The median of Model for End-stage Liver Disease score of unusual graft recipients was 13.5 (interquartile range 11.5-19.3) and that of graft-recipient weight ratio was 0.767 (0.7-0.9). ABO incompatibility was observed in four cases. The alanine aminotransferase level, total bilirubin level, and international normalized ratio decreased in both recipients and donors. Unusual and conventional grafts had similar survival rates (p = 0.492). The right and left subgroups did not differ from each counter-conventional subgroup (p = 0.339 and p = 0.695, respectively). The incidence of major complications was not significantly different between unusual and conventional graft recipients (p = 0.513). Wound seromas were reported by unusual graft donors; the complication ratio was similar to that in conventional graft donors (p = 0.169). CONCLUSION Although unusual grafts require a complex indication, they may show feasible surgical outcomes for recipients with an acceptable donor complication.
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Affiliation(s)
- Seung Hyuk Yim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Eun-Ki Min
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Mun Chae Choi
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Deok-Gie Kim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Dai Hoon Han
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Dong Jin Joo
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jin Sub Choi
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Myong Soo Kim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Gi Hong Choi
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Jae Geun Lee
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Artery Reconstruction in Right Lobe Living Donor Liver Transplantation: Donor-Recipient Vessel Ratio Is Key to Choosing Recipient Artery. Ann Plast Surg 2022; 88:674-678. [PMID: 35612536 DOI: 10.1097/sap.0000000000003232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aims of this study were to investigate if recipient artery choice in right lobe living donor liver transplant affects postoperative complications and discuss solutions accordingly. METHODS Three hundred fourteen right lobe living donor liver transplantation patients were divided into 2 groups: 163 patients using right hepatic artery as the recipient vessel and 151 patients using left hepatic artery as the recipient vessel. Cases involving 2 recipient blood vessels or the use of other blood vessels as recipient vessels were excluded. RESULTS Overall vascular embolism rate in both groups was 1.3%, and our complication rate was lower than those in previous studies. There was no significant difference in complication rate between the groups, but a significant difference in recipient/donor artery size ratio was noted. CONCLUSIONS Although left hepatic artery's anatomical position makes it less affected by bile duct anastomosis and thus fewer postoperative complications, we believe that the ratio of the donor-recipient blood vessel size and the length of the anastomosis vessel stumps are the key factors that affect the outcome of the vascular anastomosis.
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Choi TW, Chung JW, Kim HC, Lee M, Choi JW, Jae HJ, Hur S. Anatomic Variations of the Hepatic Artery in 5625 Patients. Radiol Cardiothorac Imaging 2021; 3:e210007. [PMID: 34498005 DOI: 10.1148/ryct.2021210007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/20/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
Purpose To analyze the origin and anatomic course of the hepatic arteries by using digital subtraction angiography (DSA) and multidetector CT in a large study sample. Materials and Methods This retrospective study included 5625 patients who underwent liver CT and chemoembolization between January 2005 and December 2018 (mean age, 60 years ± 11 [range, 11-99 years]; 4464 males). The CT and DSA images were reviewed to evaluate the visceral arterial anatomy for variations in the celiac axis and hepatic arteries. Aberrant right hepatic arteries (aRHAs) and aberrant left hepatic arteries (aLHAs) were defined on the basis of their origin and anatomic course. Statistical analyses were performed to evaluate the association between aRHAs and aLHAs and the association between variations in the hepatic artery and celiac axis. Results Right hepatic arteries were categorized as being aRHAs (if originating from the proximal to middle common hepatic artery, gastroduodenal artery, superior mesenteric artery [SMA], celiac axis, aorta, splenic artery, or left gastric artery [LGA]) or as being aLHAs (if arising from the LGA, celiac axis, aorta, or SMA). The prevalence of aRHAs (15.63%; 879 of 5625) and the prevalence aLHAs (16.32%; 918 of 5625) were similar. Patients with an aRHA were more likely to have an aLHA than those without an aRHA (29.01% vs 13.97%; P < .001), and patients with an aLHA were more likely to have an aRHA than those without an aLHA (27.78% vs 13.26%; P < .001). There was no association between the hepatic arterial variations and celiac axis variations. A hypothetical anatomic model summarizing the observed variations was created. Conclusion A comprehensive list of hepatic arterial variations and a three-dimensional hypothetical model for the observed variations were described.Keywords: CT, Angiography, Liver, Anatomy, Arteries© RSNA, 2021 Supplemental material is available for this article. See also commentary by Sutphin and Kalva in this issue.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Cherukuru R, Rajalingam R, Reddy MS, Rela M. Right hepatic arterial girdle around the common hepatic duct in liver donors: technical considerations for successful living donor liver transplantation. Langenbecks Arch Surg 2021; 406:1705-1709. [PMID: 34046750 DOI: 10.1007/s00423-021-02213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Variations in hepatic arterial anatomy can result in multiple arterial trunks in the graft liver. We describe our experience in dealing with five right lobe liver donors where in the right hepatic artery (RHA) branches were passing anterior and posterior to the common hepatic duct (CHD) forming an arterial girdle around it. METHODS Five of 771 right lobe living donor liver transplants (January 2012 and March 2020) demonstrated the RHA girdle around the CHD. Three patients had the typical girdle resulting in two graft arteries which were reconstructed using arterial Y grafts. Arterial girdle was formed by the right anterior hepatic artery branches in one patient resulting in 3 graft arteries of which two were reconstructed using a Y graft. One donor had the arterial girdle and an accessory artery from SMA giving rise to 3 graft arteries. Two of them were ligated (brisk back bleed), and one was reconstructed. RESULTS All donors (median follow-up 17 months, range 6-60 months) had an uneventful postoperative recovery. No vascular or biliary complications were encountered in the recipients. One recipient died due to sepsis and multiorgan failure, while the other 4 recipients recovered uneventfully and continue to have stable graft function. CONCLUSION Adhering to safe surgical principles during RHA mobilization, ligation of minor arterial branches, and precise reconstruction of multiple major branches can ensure successful outcomes in the donor and recipient in this scenario.
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Affiliation(s)
- Ramkiran Cherukuru
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India.
| | - Rajesh Rajalingam
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
- Bharath Institute of Higher Education and Research, Chennai, India
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Harada N, Yoshizumi T, Matsuura T, Taguchi T, Mori M. Usefulness of microsurgical back-table angioplasty for multiple hepatic arteries in living donor liver transplantation. Ann Gastroenterol Surg 2020; 4:735-740. [PMID: 33319164 PMCID: PMC7726678 DOI: 10.1002/ags3.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/31/2020] [Accepted: 06/14/2020] [Indexed: 11/09/2022] Open
Abstract
The graft hepatic artery orifice is tiny in living donor liver transplantation, and therefore, it is more difficult to reconstruct the hepatic artery than in deceased donor liver transplantation. In situ, multi-vessel hepatic artery reconstruction in living donor liver transplantation is time-consuming, and reconstructions are often complicated if the hepatic graft has several stumps. We describe two living donor liver transplants using back-table microsurgical angioplasty to combine two hepatic artery stumps to create a single orifice, and sequential single-vessel hepatic artery reconstruction in the recipient. Briefly, we used double-needle interrupted sutures for the two hepatic artery stumps with a biangular stay-suture method in back-table microsurgical angioplasty. Each suture was placed from the inner side of the arterial wall to the outer side, which allowed for safe and reliable suturing. After placing the interrupted sutures in the anterior wall, we turned over the vessels in the cold storage on the back table and placed interrupted sutures in the posterior wall. In the recipient, the single stump of the graft was anastomosed to the recipient's hepatic artery using an interrupted pattern and a surgical microscope. The postoperative courses of the donors and recipients were uneventful. Back-table hepatic artery angioplasty is a feasible option to overcome the complexities of multi-vessel arterial reconstruction in living donor liver transplantation. We recommend performing secure multi-vessel hepatic arterial reconstruction adapted to the clinical scenario. Using simple appropriate anastomosis, back-table microsurgical angiography may provide good results in living donor liver transplantation.
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Affiliation(s)
- Noboru Harada
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tomoharu Yoshizumi
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiharu Matsuura
- Department of Pediatric SurgeryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tomoaki Taguchi
- Department of Pediatric SurgeryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Masaki Mori
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Rare combined variations of accessory left hepatic artery and accessory right hepatic artery: a case report and literature review. Surg Radiol Anat 2019; 42:443-447. [PMID: 31811353 DOI: 10.1007/s00276-019-02396-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Variations in the hepatic artery are commonly described in the literature, which is vital for the success procedure of all hepatobiliary surgery. Usually a variation occurs in either the accessory right hepatic artery (aRHA) or the accessory left hepatic artery (aLHA). However, we report an extremely rare case where the variation occurs in both simultaneously. We over served the aRHA arising from the gastroduodenal artery and branching into the superior pancreatic duodenum artery, while the aLHA arose from the common hepatic artery and branched into right gastric artery. This situation has never been reported in literature. We will discuss the meaning of this hepatic artery variation in a clinical setting.
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Park GC, Moon DB, Kang SH, Ahn CS, Hwang S, Kim KH, Ha TY, Song GW, Jung DH, Yoon YI, Lee SG. Overcoming Hepatic Artery Thrombosis After Living Donor Liver Transplantations: An Experience from Asan Medical Center. Ann Transplant 2019; 24:588-593. [PMID: 31672958 PMCID: PMC6857352 DOI: 10.12659/aot.919650] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Hepatic artery (HA) reconstruction in living donor liver transplantation (LDLT) is more technically demanding than deceased donor LT (DDLT) because of the small diameter and short HA stump of the partial liver graft. Hence, hepatic artery thrombosis (HAT) can occur infrequently even though the HA is reconstructed microscopically. HAT is closely related to graft failure and mortality. Therefore, HAT should be detected early and HA flow reconstituted using several arterial inflows. We successfully performed redo HA reconstruction in LDLT and report our management process and outcomes. Material/Methods The right gastroepiploic artery (RGEA) was used in 15 patients, previous native HA in 3, and interposition graft from the aorta in 1. All HA reconstructions were performed under a microscope using the end-to-end interrupted suture method. We reviewed technical feasibility, cause of hepatic artery revision (HAR), patency of redo HA flow, graft salvage rate, time of revision, biliary complications, and mortality. Results Ten of 21 cases were salvage LT. Biliary complications developed in 6 cases. The mean interval of HAR with the RGEA was 1.5±1.2 postoperative days. All patients were alive without lethal complications of HAT during the mean follow-up period of 23.3 months. In the other 6 cases of HAR without using the RGEA, we performed redo HA reconstruction after thrombectomy with the native right HA (n=2), right gastric artery, left HA, gastroduodenal artery, and jump graft from the aorta (n=1, respectively). Among them, 3 died from biliary sepsis, graft dysfunction from large-sized ischemic injury, and pneumonia. Conclusions HAR with the RGEA is feasible for HAT management in LDLT patients without adequate hepatic arteries. When all inflows mentioned are unavailable, jump graft from the aorta using a cadaveric fresh iliac artery may be feasible.
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Affiliation(s)
- Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Hyun Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Balci D, Ahn CS. Hepatic artery reconstruction in living donor liver transplantation. Curr Opin Organ Transplant 2019; 24:631-636. [DOI: 10.1097/mot.0000000000000697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Chen X, Wei L, Zhu Z, Sun L, Qu W, Zeng Z. Hepatic artery reconstruction with interposition of donor's right gastroepiploic artery graft in pediatric living donor liver transplantation for metabolic disease. Pediatr Transplant 2019; 23:e13418. [PMID: 31012241 DOI: 10.1111/petr.13418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/10/2019] [Accepted: 03/21/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We introduce the indications, technique, results of our experience using donor's RGEA as interposition vessel to solve hepatic artery reconstruction problems in P-LDLT. METHODS A retrospective analysis of P-LDLT for children with metabolic diseases from June 2013 to November 2018 in our center was carried out. The arterial conditions, reconstruction methods, and prognosis were analyzed. RESULTS A total of 73 children with metabolic diseases underwent P-LDLT during the period. The LLF was the main graft, accounting for 71.2%. The donor's RGEA was utilized in five cases. There were three children with OTCD and two children with deficiency of CPS1 and MSUD, respectively. In three cases, the grafts' left hepatic arteries were anastomosed with the recipients' PHA using donors' RGEA as interposition vessel. In other two cases, the donors' RGEA was interposed between graft's MHA and the recipient's bifurcation of PHA and GDA. The average follow-up time was 19.7 ± 15.9 month. There were two cases of artery thrombosis or occlusion, and the incidence was 2.7%. No arterial complications occurred in children using RGEA (follow-up time 5.0 ± 3.4 months). CONCLUSION In P-LDLT for patients with metabolic diseases, the application of RGEA as an interposition vessel can solve caliber mismatch and short arteries problem and achieve good results. Compared with traditional arterial anastomosis, it may reduce the incidence of arterial complications.
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Affiliation(s)
- Xiaojie Chen
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lin Wei
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhijun Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China
| | - Liying Sun
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
| | - Wei Qu
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhigui Zeng
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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12
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Liang Y, Li E, Min J, Gong C, Wu L. Rare anatomic variation of the right hepatic artery and accessory right hepatic artery supplying hepatocellular carcinoma: A case report and literature review. Medicine (Baltimore) 2017; 96:e8144. [PMID: 28953651 PMCID: PMC5626294 DOI: 10.1097/md.0000000000008144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Each hepatic artery is functionally essential for providing blood supply to the liver, and so are variant arteries. Variant arteries, including the accessory right hepatic artery (ARHA) and replaced right hepatic artery (RRHA) are commonly described in the literature. However, they usually occur independently. Here, we report an extremely rare case that involved both an ARHA and an RRHA arising from the gastroduodenal artery (GDA) and superior mesenteric artery (SMA), respectively. To date, this situation has never been reported in the literature.They were preoperatively identified during magnetic resonance imaging (MRI) examination in a 69-year-old male patient with hepatocellular carcinoma. And they were further verified by following conventional angiography for transcatheter arterial chemoembolization (TACE) for the patient. In addition, the patient's tumor was primarily supplied by these 2 variant arteries. After the successful TACE procedure, the patient had a well postoperative recovery. CONCLUSIONS By analyzing this case and performing a systematic review of the literature, the important clinical implications of the ARHA and RRHA will be investigated and discussed. Main lessons learned from this case thorough understanding of the normal anatomy of the hepatic artery and its anatomic variation is crucial for surgeons and interventional radiologists; preoperative computed tomography, MRI, and intraoperative angiography play an important role in detecting the variant hepatic artery; identifying these anomalous hepatic arteries before operation can effectively avoid unintentional injury during surgery, such as massive hemorrhage or hepatic infarction.
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Affiliation(s)
- Yiming Liang
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University
| | - Enliang Li
- Department of General Surgery, Children's Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Jiaqi Min
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University
| | - Chengwu Gong
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University
| | - Linquan Wu
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University
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Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications. ANATOMY RESEARCH INTERNATIONAL 2015; 2015:591961. [PMID: 26635976 PMCID: PMC4655262 DOI: 10.1155/2015/591961] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
Abstract
Anatomy of ophthalmic artery has been thoroughly studied and reviewed in many anatomical and surgical textbooks and papers. Issues of interest are its intracranial and extracranial course, its branches, its importance for vision, and its interaction with various intracranial pathologies. Improvement of our understanding about pathophysiology of certain diseases like aneurysm formation, central retinal artery occlusion, and retinoblastoma and also invention of new therapeutic modalities like superselective catheterization, intra-arterial fibrinolysis, and intra-arterial chemotherapy necessitate a reappraisal of its anatomy from a clinical point of view. The aim of this review is to examine clinical anatomy of ophthalmic artery and correlate it with new diagnostic and therapeutic applications.
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Aramburu J, Antón R, Bernal N, Rivas A, Ramos JC, Sangro B, Bilbao JI. Physiological outflow boundary conditions methodology for small arteries with multiple outlets: A patient-specific hepatic artery haemodynamics case study. Proc Inst Mech Eng H 2015; 229:291-306. [DOI: 10.1177/0954411915578549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physiological outflow boundary conditions are necessary to carry out computational fluid dynamics simulations that reliably represent the blood flow through arteries. When dealing with complex three-dimensional trees of small arteries, and therefore with multiple outlets, the robustness and speed of convergence are also important. This study derives physiological outflow boundary conditions for cases in which the physiological values at those outlets are not known (neither in vivo measurements nor literature-based values are available) and in which the tree exhibits symmetry to some extent. The inputs of the methodology are the three-dimensional domain and the flow rate waveform and the systolic and diastolic pressures at the inlet. The derived physiological outflow boundary conditions, which are a physiological pressure waveform for each outlet, are based on the results of a zero-dimensional model simulation. The methodology assumes symmetrical branching and is able to tackle the flow distribution problem when the domain outlets are at branches with a different number of upstream bifurcations. The methodology is applied to a group of patient-specific arteries in the liver. The methodology is considered to be valid because the pulsatile computational fluid dynamics simulation with the inflow flow rate waveform (input of the methodology) and the derived outflow boundary conditions lead to physiological results, that is, the resulting systolic and diastolic pressures at the inlet match the inputs of the methodology, and the flow split is also physiological.
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Affiliation(s)
- Jorge Aramburu
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, Tecnun-University of Navarra, Donostia-San Sebastián, Spain
| | - Raúl Antón
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, Tecnun-University of Navarra, Donostia-San Sebastián, Spain
| | - Nebai Bernal
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, Tecnun-University of Navarra, Donostia-San Sebastián, Spain
| | - Alejandro Rivas
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, Tecnun-University of Navarra, Donostia-San Sebastián, Spain
| | - Juan Carlos Ramos
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, Tecnun-University of Navarra, Donostia-San Sebastián, Spain
| | - Bruno Sangro
- Clínica Universidad de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Lee SG. Liver retransplantation for adult recipients. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2013; 17:1-7. [PMID: 26155206 PMCID: PMC4304506 DOI: 10.14701/kjhbps.2013.17.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 02/11/2013] [Accepted: 02/16/2013] [Indexed: 01/19/2023]
Abstract
Living donor liver graft can be used for the first or second liver transplantation. The timing of retransplantation also should be stratified as 2 types according to the reoperation timing. Combination of these two classifications results in 6 types of living donor liver transplantation (LDLT)-associated retransplantation. However, late retransplantation to LDLT might have not been performed in most LDLT programs, thus other 4 types of LDLT-associated retransplantation can be taken into account. The most typical type of LDLT-associated retransplantation might be early living donor-to-deceased donor retransplantation. For early living donor-to-living donor retransplantation, its eligibility criteria might be similar to those of early living donor-to-deceased donor retransplantation. For early deceased donor-to-living donor retransplantation, its indications are exactly the same to those for aforementioned living donor-to-living donor retransplantation. Late deceased donor retransplantation after initial LDLT has the same indication for ordinary late deceased donor retransplantation.
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Affiliation(s)
- Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ahn CS, Hwang S, Moon DB, Song GW, Ha TY, Park GC, Namgoong JM, Yoon SY, Jung SW, Jung DH, Kim KH, Park YH, Park HW, Lee HJ, Park CS, Lee SG. Right gastroepiploic artery is the first alternative inflow source for hepatic arterial reconstruction in living donor liver transplantation. Transplant Proc 2012; 44:451-3. [PMID: 22410041 DOI: 10.1016/j.transproceed.2012.01.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sufficient arterial flow after living donor liver transplantation (LDLT) is closely related to graft survival and prevention of postoperative complications. However, some unfavorable hepatic arterial conditions in recipients preclude reconstruction, requiring alternative stumps. We have used the right gastroepiploic artery (RGEA) as a first alternative for hepatic inflow. METHODS From January 2006 to December 2008, we performed 754 LDLTs including 28 cases of RGEA among hepatic arterial anastomoses. The arterial anastomosis was performed by an single surgeon under 859 a microscope using an end-to-end interrupted suture technique. RGEA was mobilized over 15 cm from the greater curvature of stomach and greater omentum. RESULTS The indications for RGEA use included severe hepatic arterial injury from previous transarterial chemoembolization (n=14), need for additional arterial flow in dual-grafts LDLT (n=13), poor blood flow from the recipient hepatic artery (n=3), and arterial injury during hilar dissection (n=3). The mean diameter of the isolated RGEA was 2.0±0.2 mm (range: 1.0-2.5). Most hepatic arterial anastomoses were performed with a significant size discrepancy of more than twofold. All reconstructed hepatic arterial flowes showed good; no complication was identified during the mean follow-up period of 56 months to date. CONCLUSIONS Using RGEA as an alternative arterial inflow is a simple, reliable procedure for situations of inadequate recipient hepatic or multiple graft arteries.
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Affiliation(s)
- C-S Ahn
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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17
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Lee HJ, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Namgoong JM, Yoon SY, Jung SW, Park HW, Park CS, Park YH, Lee SG. Long-Term Outcomes of Portal Y-Graft Interposition for Anomalous Right Portal Veins in Living Donor Liver Transplantation. Transplant Proc 2012; 44:454-6. [DOI: 10.1016/j.transproceed.2012.01.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kim SJ, Yoon YC, Park JH, Oh DY, Yoo YK, Kim DG. Hepatic artery reconstruction and successful management of its complications in living donor liver transplantation using a right lobe. Clin Transplant 2011; 25:929-38. [PMID: 21954993 DOI: 10.1111/j.1399-0012.2010.01385.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of the present study was to improve the techniques of hepatic artery (HA) reconstruction and to properly manage arterial complications after living donor liver transplantation (LDLT). METHODS Prospectively collected data collected from 371 patients who underwent adult LDLT using a right lobe from January 2000 to August 2009 were retrospectively reviewed. RESULTS Of 17 patients (4.6%, 17/371) with double HA stumps in the graft, 12 patients (70.6%) received dual HA reconstruction. HA complications were composed of thrombosis (n = 6), pseudoaneurysm (n = 2), and stenosis (n = 4), showing 3.2% (12/371) of incidence. In patients with HA thrombosis, whereas operative thrombectomies with re-anastomosis rescued all the grafts in early attack (n = 3, ≤1 wk), angiographic thrombolysis successfully reestablished the flow in patients with late attack (n = 3, >1 wk). In all patients with HA complications, except for one, all of our treatment modalities - operation and angiographic intervention - resulted in successful rescue of grafts and no patient received re-transplantation because of HA complications. CONCLUSION Prompt diagnosis of HA complications by serial post-operative Doppler ultrasound and corresponding treatment strategies, including operative and radiological intervention, can rescue both grafts and patients without necessitating re-transplantation.
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Affiliation(s)
- Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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19
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Kim BW, Xu W, Wang HJ, Park YK, Lee K, Kim MW. Volumetry-based selection of right posterior sector grafts for adult living donor liver transplantation. Liver Transpl 2011; 17:1046-58. [PMID: 21594965 DOI: 10.1002/lt.22338] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To determine the feasibility of volumetric criteria without anatomic exclusion for the selection of right posterior sector (RPS) grafts for adult-to-adult living donor liver transplantation (LDLT), we reviewed and compared our transplant data for RPS grafts and right lobe (RL) grafts. Between January 2008 and September 2010, adult-to-adult LDLT was performed 65 times at our institute; 13 of the procedures (20%) were performed with RPS grafts [the posterior sector (PS) group], and 39 (60%) were performed with RL grafts (the RL group). The volumetry of the 13 RPS donor livers showed that the RPS volume was 39.8% ± 7.6% of the total liver volume. Ten of the 13 donors had to donate RPS grafts because the left liver volume was inadequate. All donor procedures were performed successfully, and all donors recovered from hepatectomy. However, longer operative times were required for the procurement of RPS grafts versus RL grafts (418 ± 40 versus 345 ± 48 minutes, P < 0.001). The postoperative recovery of liver function was smoother for the donors of the PS group versus the donors of the RL group. The RPS grafts had significantly smaller hepatic artery and bile duct openings than the RL grafts. All recipients with RPS grafts survived LDLT. No recipients experienced vascular graft complications or small-for-size graft dysfunction. There were no significant differences in the incidence of posttransplant complications between the donors and recipients of the PS and RL groups. The 3-year graft survival rates were favorable in both groups (100% in the PS group versus 91% in the RL group). In conclusion, the selection of RPS grafts by volume criteria is a feasible strategy for an adult-to-adult LDLT program.
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Affiliation(s)
- Bong-Wan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
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Bageacu S, Abdelaal A, Ficarelli S, ElMeteini M, Boillot O. Anatomy of the right liver lobe: a surgical analysis in 124 consecutive living donors. Clin Transplant 2011; 25:E447-54. [DOI: 10.1111/j.1399-0012.2011.01466.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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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; 16:2682-8. [PMID: 20518092 PMCID: PMC2880783 DOI: 10.3748/wjg.v16.i21.2682] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/23/2010] [Accepted: 03/02/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To retrospectively investigate microsurgical hepatic artery (HA) reconstruction and management of hepatic thrombosis in adult-to-adult living donor liver transplantation (A-A LDLT). METHODS From January 2001 to September 2009, 182 recipients with end-stage liver disease underwent A-A LDLT. Ten of these patients received dual grafts. The 157 men and 25 women had an age range of 18 to 68 years (mean age, 42 years). Microsurgical techniques and running sutures with back-wall first techniques were performed in all arterial reconstructions under surgical loupes (3.5 x) by a group of vascular surgeons. Intimal dissections were resolved by interposition of the great saphenous vein (GSV) between the donor right hepatic artery (RHA) and recipient common HA (3 cases) or abdominal aorta (AA) (2 cases), by interposition of cryopreserved iliac vessels between the donor RHA and recipient AA (2 cases). RESULTS In the 58 incipient patients in this series, hepatic arterial thrombosis (HAT) was encountered in 4 patients, and was not observed in 124 consecutive cases (total 192 grafts, major incidence, 2.08%). All cases of HAT were suspected by routine color Doppler ultrasonographic examination and confirmed by contrast-enhanced ultrasound and hepatic angiography. Of these cases of HAT, two occurred on the 1st and 7th d, respectively, following A-A LDLT, and were immediately revascularized with GSV between the graft and recipient AA. HAT in one patient occurred on the 46th postoperative day with no symptoms, and the remaining case of HAT occurred on the 3rd d following A-A LDLT, and was cured by thrombolytic therapy combined with an anticoagulant but died of multiorgan failure on the 36th d after A-A LDLT. No deaths were related to HAT. CONCLUSION Applying microsurgical techniques and selecting an appropriate anastomotic artery for HA reconstruction are crucial in reducing the high risk of HAT during A-A LDLT.
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Use of Recipient's Left Hepatic Artery for Artery Reconstruction in Right Lobe Living Donor Liver Transplantation With Duct-to-Duct Anastomosis. Transplantation 2010; 89:1016-21. [DOI: 10.1097/tp.0b013e3181ce77c4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim JD, Choi DL, Han YS. Hepatic Artery Reconstruction Using the Right Gastroepiploic Artery for Hepatic Artery Inflow in a Living Donor Liver Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joo Dong Kim
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Dong Lak Choi
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Young Seok Han
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
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Basciano CA, Kleinstreuer C, Kennedy AS, Dezarn WA, Childress E. Computer modeling of controlled microsphere release and targeting in a representative hepatic artery system. Ann Biomed Eng 2010; 38:1862-79. [PMID: 20162358 DOI: 10.1007/s10439-010-9955-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 02/01/2010] [Indexed: 01/08/2023]
Abstract
Combating liver tumors via yttrium-90 ((90)Y) radioembolization is a viable treatment option of nonresectable liver tumors. Employing clinical (90)Y microparticles (i.e., SIR-Spheres and TheraSpheres) in a computational model of a representative hepatic artery system, laminar transient 3D particle-hemodynamics were simulated. Specifically, optimal particle release positions in the right hepatic (parent) artery as well as the best temporal release window were determined for the microspheres to exit specific outlet daughter vessels, potentially connected to liver tumors. The results illustrate the influence of a curved geometry on the velocity field and the particle trajectory dependence on the spatial and temporal particle injection conditions. The differing physical particle characteristics of the SIR-Spheres and the TheraSpheres had a subtle impact on particle trajectories in the decelerating portion of the arterial pulse, i.e., when the inertial forces on the particles are weaker. Conversely, particle characteristics and inelastic wall collisions had little effect on particles released during the accelerating phase of the arterial pulse, i.e., both types of microspheres followed organized paths to predetermined outlets. Such results begin paving the way towards directing 100% of the released microspheres to specific daughter vessels (e.g., those connected to tumors) under transient flow conditions in realistic geometries via a novel drug-particle targeting methodology.
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Affiliation(s)
- Christopher A Basciano
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA
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Hwang S, Lee SG, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Ryu JH, Ko KH, Choi NK, Kim KW. Technique and outcome of autologous portal Y-graft interposition for anomalous right portal veins in living donor liver transplantation. Liver Transpl 2009; 15:427-34. [PMID: 19326410 DOI: 10.1002/lt.21697] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study was intended to describe in detail the surgical technique and long-term outcome of autologous portal vein (PV) Y-graft interposition for adult living donor liver transplantation (LDLT). We assessed the outcome of 841 patients who underwent right lobe LDLT from January 2002 to December 2007 with respect to the reconstruction of double-graft PVs. PV anatomy of the donor livers was classified as type I in 796 patients (94.6%), type II in 15 patients (1.8%), and type III in 30 patients (3.6%). Seven type II grafts and all type III PV grafts had double PV orifices. Autologous PV Y-graft interposition was used in 31 patients, and complications occurred in only 1 patient during a median follow-up of 27 months. Overall, the 1- and 3-year graft survival rates were 87.5% and 80.6%, respectively. Use of a Y-graft was not a risk factor for biliary complications, but the liver anatomy of anomalous PV per se seems to be associated with a higher occurrence of biliary complications, especially during the early posttransplant period. The favorable outcome and technical feasibility of autologous portal Y-graft interposition imply that this technique could be the standard procedure for reconstruction of right lobe grafts with double PV orifices.
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Affiliation(s)
- Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Silveira LAD, Silveira FBC, Fazan VPS. Arterial diameter of the celiac trunk and its branches: anatomical study. Acta Cir Bras 2009; 24:43-7. [DOI: 10.1590/s0102-86502009000100009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 11/12/2008] [Indexed: 01/17/2023] Open
Abstract
PURPOSE: Despite the fact that anatomical variations of the celiac trunk are well explored in the literature, information on these vessels diameters is scanty. The aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases presenting anatomical variations of these vessels. METHODS: Twenty-one formalin fixed adult male cadavers were appropriately dissected for the celiac trunk identification and arterial diameter measurements. Arteries measured included the celiac trunk and its main branches (splenic artery, left gastric artery and common hepatic artery), as the proper hepatic artery, right gastric artery, the left and right hepatic arteries and the gastroduodenal artery. RESULTS: From the 21 cadavers, 6 presented anatomical variations of, at least, one of the above mentioned branches. The average arterial diameter comparisons between groups (normal and variable) clearly showed smaller diameters for variable vessels, but with no significant difference. CONCLUSION: Our data indicates the possibility of a diameter reduction of the celiac trunk main branches in the presence of anatomical variations. This should be taken into account on the selection for the liver transplantation donors.
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D’Albuquerque L, Gonzalez A, Letrinda R, Copstein J, Larrea F, Mansero J, Peron G, Ribeiro M, Oliveira e Silva A. Use of the Splenic Artery for Arterial Reconstruction in Living Donor Liver Transplantation. Transplant Proc 2007; 39:3202-3. [DOI: 10.1016/j.transproceed.2007.03.105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 03/05/2007] [Indexed: 10/22/2022]
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Yan L, Li B, Zeng Y, Wen T, Zhao J, Wang W, Yang J, Xu M, Ma Y, Chen Z, Liu J, Wu H. Preliminary experience in adult-to-adult living donor liver transplantation in a single center in China. FRONTIERS OF MEDICINE IN CHINA 2007; 1:136-41. [PMID: 24557665 DOI: 10.1007/s11684-007-0026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 12/10/2006] [Indexed: 02/05/2023]
Abstract
The aim of this paper is to report the authors' experience in performing adult-to-adult living donor liver transplantation (LDLT) by using a modified technique in using grafts of the right lobe of the liver. From January 2002 to September 2006, 56 adult patients underwent LDLT using right lobe grafts at the West China Hospital, Sichuan University Medical School, China. All patients underwent a modified operation designed to improve the reconstruction of the right hepatic vein (RHV) and the tributariers of the middle hepatic vein (MHV) by interposing a vessel graft, and by anastomosing the hepatic arteries and bile ducts. There were no severe complications or deaths in all donors. Fifty-two (92.8%) recipients survived the operations. Among the 56 recipients, complications were seen in 15 recipients (26.8%), including hepatic vein stricture (one case), small-for-size syndrome (one case), hepatic artery thrombosis (two cases), intestinal bleeding (one case), bile leakage (two cases), left subphrenic abscess (one case), renal failure (two cases) and pulmonary infection (five cases). Within three months after transplantation, four recipients (7.14%) died due to small-for-size syndrome (one case), renal failure (one case) and multiple organ failure (two cases). All patients underwent direct anastomoses of the RHV and the inferior vena cava (IVC), and in 23 cases, reconstruction of the right inferior hepatic vein was also done. In 24 patients, the reconstruction of the tributaries of the MHV was also done by interposing a vessel graft to provide sufficient venous outflow. Trifurcation of the portal vein was seen in nine cases. Thus, veno-plasty or separate anastomoses were performed. The graft and recipient body weight ratios (GRWR) were between 0.72% and 1.43%, and in three cases it was <0.8%. The graft weight to recipient standard liver volume ratios (GV/SLV) were between 31.86% and 71.68%, among which four cases had <40%. No "small-for-size syndrome" occurred. With modification of the surgical technique, especially in the reconstruction of the hepatic vein to provide sufficient venous outflow, living donor liver grafts in adults using the right lobe of the liver can become a relatively safe procedure and prevent the "small-for-size syndrome".
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Affiliation(s)
- Lunan Yan
- Liver Transplantation Division, Department of Surgery, West China Hospital, Sichun University Medical School, Chengdu, 610041, China,
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