SHOULD ALL HEPATIC ARTERIAL BRANCHES BE RECONSTRUCTED IN LIVING-RELATED LIVER-TRANSPLANTATION

Background. Because graft arteries are smaller and shorter in living-r elated liver transplantation (LRLT) than in whole or reduced-size live r transplantation from cadavers, arterial reconstruction is thought to be one of the critical points for success. Methods. Thirty LRLT patie nts were classified into two groups: those in whom all graft hepatic a rteries were reconstructed (group A), and those in whom only some were reconstructed (group B). In group A 17 patients had a single hepatic artery and three had two hepatic arteries. In group B the thickest one of several arteries was reconstructed, but the others were ligated af ter pulsatile back-bleeding from their cut stumps had been confirmed. The clinical results were compared between the two groups. Results. Ne ither arterial thrombosis nor liver dysfunction related to the arteria l blood supply was observed during the postoperative course. One case of bile leakage and two cases of bile duct stenosis occurred in group A. No significant difference was noted in the postoperative values of aspartate aminotransferase, alanine aminotransferase, and lactate dehy drogenase between the two groups. Overall patient and graft survival w as 90%. Conclusions. Although several hepatic arteries may supply the potential allograft in LRLT, it is not always necessary to reconstruct all of them.