Background: Reconstruction of the hepatic artery is the most difficult stage of liver transplantation from a living donor. Vascular complications after liver transplantation exacerbate postoperative morbidity. The aim is to evaluate the results of complex arterial reconstruction during liver transplantation in our clinic.
Methods: From December 2011 to April 2024, 279 TP was performed for adults and children at the National Research Center named after A.N. Syzganov. Living donor liver transplantation was performed in 251 (90%) patients, including pediatric liver transplantation (17.2%) cases, and deceased donor liver transplantation in 28 (10%) cases.
Postoperative complications were 99 (39.4%) cases: biliary complications 35 (14.0%), bleeding 15 (6.0%), relaparotomy 20 (8.0%), rejection was observed in 10 (4.0%) cases, non-compliance 9 (3.6%) cases, vascular complications were 21 (8.3%), of these: arterial complications 11 (4.3%), portal anastomosis 4 (1.6%), anastomoses of hepatic veins 6 (2.4%).
Results: The overall survival rate of patients after living donor liver transplantation was: 5 years– 74.3%; 10 years–71.7%. Of the 11 (4.3%) complications associated with arterial anastomosis, intraoperative were in 7 (2.7%) cases. Of these, in 6 (2.4%) cases with intimal dissection, anastomosis was performed between the graft artery and the recipient's gastro-omentum artery. In 1 (0.4%) case, extraanatomic arterial reconstruction "jump graft" with an autograft from a large saphenous vein. In the remaining 4 (1.6%) cases, they were postoperative and required complex arterial reconstruction after a typical arterial anastomosis. The success rate in all cases is 100%.
Conclusion: A good arterial anastomosis plays an important role in liver transplantation from a living donor. An alternative option for reconstruction of the hepatic artery is primarily the gastro-omentum artery. If it is impossible, other options are used (large saphenous vein, etc.).