The Reconstruction of Hepatic Arteries Using Extra-Anatomical Free Autografts in Living Donor Liver Transplantation
Shigehito Miyagi*, Kenji Shimizu, Koji Miyazawa, Yuta Kakizaki, Atsushi Fujio, Yasuyuki Hara, Chikashi Nakanishi, Hitoshi Goto, Takashi Kamei, Naoki Kawagishi, Noriaki Ohuchi and Susumu Satomi
Division of Transplantation, Tohoku University, Japan
- *Corresponding Author:
- Shigehito Miyagi
Division of Transplantation
Upper Digestive and Vascular Surgery
Tohoku University, 1-1 Seiryo-machi
Aoba-ku, Sendai 980-8574, Japan
E-mail: [email protected]
Received Date: December, 31 2015; Accepted Date: February, 19 2016; Published Date: February, 26 2016
Citation: Miyagi S, Shimizu K, Miyazawa K, Kakizaki Y, Fujio A, et al. (2016) The Reconstruction of Hepatic Arteries Using Extra-Anatomical Free Autografts in Living Donor Liver Transplantation. J Transplant Technol Res 6: 157. doi: 10.4172/2161-0991.1000157
Copyright: © 2016 Miyagi S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Objectives: In living-donor liver transplantation (LDLT), microsurgical reconstruction of a hepatic artery is essential but requires challenging techniques, because graft arteries are short and usable vessel grafts are limited. Furthermore, hepatic artery thrombosis can be a lethal complication. Extra-anatomical jump graft reconstruction using free grafts is reported to have a high reocclusion rate. However, this technique is necessary when there is no other option. We report 4 cases of LDLT that required extra-anatomical reconstruction technique using free autografting from the aorta to the hepatic artery. In this technique, we used the systemic administration of gabexate mesilate that is the strong serine protease inhibitor.
Methods: From 1991 to 2015, we performed 164 LDLTs. We retrospectively investigated 4 cases of extraanatomical reconstruction of the hepatic artery using free autografting from the aorta to the hepatic artery.
Results: Two cases initially underwent anatomical reconstruction, but the arteries occluded early, because of the dissection of recipient’s artery. There was no arterial graft, so we performed extra-anatomical reconstruction by using free autografting from the aorta to the hepatic artery. In the other two cases, the recipient arteries could not be used. Therefore, we initially performed extra-anatomical reconstruction by using radial artery free autografting as jump grafts from the aorta to the hepatic artery. In all cases, we used the systemic administration of gabexate mesilate, and could rescue all cases.
Conclusion: We experienced and were able to salvage 4 cases that required free autografts. When there is no other means of reconstructing arteries, it is necessary to perform this procedure, depending on the condition of the intima of the recipient artery.