Variations of surgical reconstruction in liver transplantation depending on vasculature

Background: From September 1988 through April 1998, 1000 liver transplantat ions were performed on 911 patients. The standard technique for liver re-va scularization to,guarantee an optimal blood inflow during transplantation w as modified in 19% of the cases on the arterial side and in 5.6% of the cas es on the portal side as a result of unusual anatomical features and pathol ogical changes in the vasculature of the organ recipient. In 113 transplant ations, successful reconstruction of accessory vessels of the graft (12 lef t and 101 right hepatic arteries) was performed without complications. It i s our opinion that preoperative diagnosis of the vasculature (stenoses of t he celiac trunk etc.) of the organ recipient by duplexsonography and angiog raphy is necessary. Even with the help of these tests, it is extremely diff icult to diagnose a "steal" syndrome in the splenic artery: for example, 31 of 40 patients with poor liver function received postoperative therapy for newly diagnosed "steals". Results and conclusions: There is no increase in complications (stenosis and thrombosis) with modifications of arterial rec onstruction (4.9 vs 6.3%); however, with modification of portal reconstruct ion the increase is from 2.4% to 8.3%.