Background: Hepatic artery reconstruction (HAR) is a critical aspect of living donor liver transplantation (LDLT). However, hepatic artery anastomosis poses challenges, particularly for transplant surgeons with limited experience.
Methods: This retrospective study evaluated the outcomes of 24 LDLTs conducted at our institution between January 2019 and October 2023. All donor surgeries were performed laparoscopically. Cases were categorized into two groups based on the sequence of tie placement after hepatic artery suture or initiation of reperfusion.
Results: Microanastomoses were performed in all 24 cases (100%) using a magnifying surgical loupe. Hepatic artery anastomosis was conducted using the conventional twisting technique. Following hepatic artery suture completion, cases were divided into tie-first (n=11, 45.8%) and reperfusion-first (n=13, 54.2%) groups. The mean diameter of the donor graft hepatic artery was 2.09±0.3mm in the tie-first group and 1.92±0.27mm in the reperfusion-first group, with no significant difference observed (p=0.17). In the reperfusion-first group, intraoperative revision occurred in 7 cases (53.8%), significantly higher than the 1 case (9.1%) in the tie-first group (p=0.02).
Conclusion: For less experienced transplant surgeons, we recommend performing tie first followed by reperfusion to reduce hepatic artery complications in living donor liver transplantation.