Use of an aberrant right hepatic artery arising from the superior mesenteric artery of the recipient for arterial reconstruction in liver transplantation
Robert P. Sutcliffe, Evangelos Lolis, Andreas A. Prachalias, Parthi Srinivasan, Mohamed Rela, Mohamed Rela, Nigel D. Heaton
Ann Transplant 2010; 15(4): 44-48
Background: Our aim was to report a single centre experience of using a recipient’s aberrant right hepatic artery (RHA) from the superior mesenteric artery (SMA) to establish inflow into liver allografts.
Material/Methods: All patients who had arterial reconstruction with an aberrant RHA were identified from a prospective database (1989-2004). Indications and outcomes were evaluated, with particular reference to arterial complications.
Results: An aberrant RHA was used in 27/2518 recipients (1%), including 6 paediatric recipients. Indications were replaced CHA (4), hypoplastic CHA (7), atheroma (12), previous conduit (1) and poor post-anastomotic flow (3). After a median of 42 months, arterial complications occurred in 2 paediatric recipients (hepatic artery thrombosis 1; arterial stenosis 1). Four patients developed anastomotic biliary strictures, and one paediatric recipient developed ischaemic cholangiopathy after hepatic artery thrombosis. Two patients underwent retransplantation (one patient with arterial stenosis). 1-year and 5-year patient survival rates were 85% and 81%. There were 6 deaths unrelated to vascular complications.
Conclusions: In adult liver transplant recipients with an unsuitable common hepatic artery, an aberrant right hepatic artery may be used to establish arterial inflow. This technique may be associated with a higher rate of vascular complications in paediatric recipients, and should be used cautiously in this group.
Keywords: Liver Transplantation, replaced right hepatic artery, accessory right hepatic artery, steal syndrome, hepatic artery thrombosis