RT Book, Section
A1 Cano Busnelli, Virginia M.
A1 Huespe, Pablo E.
A1 de Santibañes, Martin
A2 Molmenti, Ernesto Pompeo
A2 Santibañes, Martin de
A2 Santibañes, Eduardo de
SR Print(0)
ID 1180112767
T1 Arterial Reconstruction
T2 Liver Transplantation: Operative Techniques and Medical Management
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260462517
LK accesssurgery.mhmedical.com/content.aspx?aid=1180112767
RD 2023/03/25
AB A  proper  reconstruction  of  afferent  and  efferent  vessels  is  a  sine  qua  non  condition  for  successful  liver  transplantation.  Reduced  blood  inflow  due  to  technical  problems  often  lead  to  early  postoperative  graft  loss  or  long-term  complications  and  need  for  retransplantation.1  Vascular  complications  ranges  from  2%  to  25%  in  most  publications.2  Arterial  complications  prevail,  and  thrombosis  is  the  most  common.  According  to  a  systematic  review  by  Bekker  et  al.,3  the  incidence  of  early  hepatic  artery  thrombosis  (eHAT)  was  8.3%  in  children  and  2.9%  in  adults  (p  <0.001)  with  an  overall  retransplantation  rate  of  61.9%  in  children  and  50%  in  adults.  The  overall  mortality  rate  of  patients  with  eHAT  was  33.3%  (range:  0%  to  80%).  Mortality  in  adults  (34.3%)  was  higher  than  in  children  (25%,  p  <0.03).  Thus,  the  determination  of  the  preoperative  vascular  status  of  the  recipient  is  mandatory,  as  well  as  in  the  donor  organ.  Given  that  the  vascular  status  of  the  donor  organ  is  not  always  possible  to  assess  preoperatively,  a  very  careful  harvest  of  the  organ  is  necessary  for  optimal  transplant  revascularization  due  to  the  multitude  of  arterial  variants  and  pathologic  changes  in  the  afferent  liver  vasculature.