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• W2080861339 abstract "The most frequent vascular complication after liver transplantation is hepatic arterial thrombosis (HAT). Although possible therapy for acute HAT may be revascularization or retransplantation to salvage the graft, those methods may be difficult to perform. In this article, we describe a case of a successful living-donor liver transplantation (LDLT) with partial portal arterialization (PPA) for hepatic artery occlusion. A 27-year-old woman with biliary atresia was referred to Kanazawa University Hospital for LDLT. The right hepatic lobe from her 28-year-old sister was procured for transplantation. On harvesting, the right hepatic artery was dissected close to the liver hilum, because of a dissecting aneurysm of the right hepatic artery, which had occurred accidentally. After performing the recipient hepatectomy, the graft was anastomosed in the usual sequential fashion. On completion of all vascular anastomoses, intraoperative Doppler ultrasonography failed to identify hepatic arterial flow. It was considered that a dissecting aneurysm of the hepatic artery of the graft might have induced hepatic artery occlusion. Because reanastomosis of the hepatic artery was impossible, PPA was performed by constructing an arteriovenous shunt 2 mm in diameter in the mesenteric vascular branches, aimed at improving oxygen delivery to the graft. The anastomosis was performed with 8-0 interrupted monofilament suture using magnification loupes. The patient recovered uneventfully, with good graft function during the early postoperative period. Although Doppler ultrasonography revealed no hepatic arterial flow during the early postoperative period, serum liver enzymes and bilirubin were promptly returned to normal values. On postoperative day (POD) 45, occlusion of the hepatic artery and development of collateral vessels to the graft from the inferior pancreatic duodenal artery were observed radiologically. The patency of the arteriovenous shunt was not confirmed (Fig. 1). Graft volume estimated by computed tomographic volumetry was 1,730 mL on POD 31. The patient was discharged in good health on POD 59. Fourteen months after LDLT, the patient continues to do well, with normal graft function.Figure 1: (A) Arterial phase of celiac artery angiogram demonstrating occlusion of hepatic artery (arrow). (B) Arterial phase of superior mesenteric artery angiogram demonstrating collateral artery from inferior pancreatic duodenal artery (arrow).There are several reports showing that PPA is effective in preventing hepatic failure caused by interruption of hepatic arterial flow (1,2). It has been pointed out that portal arteriovenous shunting carries a risk of delayed portal hypertension (3). However, in our previous experimental study, the increase of portal pressure after construction of PPA was slight when the arterial flow into the portal circulation was not excessive. Furthermore, the mesenteric arteriovenous shunt was effective in preventing hepatic function and morphology (4,5). In the present case, PPA was performed by constructing an arteriovenous shunt in the mesenteric vascular branches, to avoid ischemic injury to the graft. This was not followed by any clinically apparent portal hypertension during the short operative period. As the purpose of this method is to maintain oxygen supply to the graft until collateral arteries develop sufficiently to accomplish this, the mesenteric arteriovenous shunt does not have to be permanently patent. In fact, in the present case, formation of collaterals was confirmed and the mesenteric arteriovenous shunt spontaneously occluded on POD 45. When HAT occurs after LDLT, we should first perform revascularization to salvage the graft. However, the success rate of revascularization is not acceptable. Therefore, we suggest that PPA can be a useful option to salvage the graft and the patient, even if revascularization cannot be performed. Koichi Shimizu Takashi Tani Hiroyuki Takamura Hironori Hayashi Masaki Takeshita Kojiro Funaki Toru Yamazaki Itasu Ninomiya Koichi Miwa" @default.
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• W2080861339 date "2004-03-27" @default.
• W2080861339 modified "2023-10-05" @default.
• W2080861339 title "Partial portal arterialization in living-donor liver transplantation for hepatic artery occlusion" @default.
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• W2080861339 doi "https://doi.org/10.1097/01.tp.0000116561.66472.77" @default.
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