Microvascular Hepatic Artery Anastomosis in Pediatric Living Donor Liver Transplantation: 73 Consecutive Cases by a Single Surgeon

Background: Living donor liver transplantation (LDLT) is an important strategy of procuring segmental liver allografts for pediatric patients with liver failure, as suitably sized whole donor organs are scarce. Early pediatric LDLT experience was associated with high rates of hepatic artery thrombosis, graft loss, and mortality. Collaboration with microsurgeons for hepatic artery anastomosis in pediatric LDLT has decreased rates of arterial complications; however, reported outcomes are limited. Methods: A 14-year retrospective review was undertaken of children at our institution who underwent LDLT with hepatic artery anastomosis performed by a single microsurgeon using an operating microscope. Data were collected on demographics, etiology of liver failure, graft donor, vessel calibre, vessel anastomosis, arterial complications, and long-term follow up. Results: Seventy-three children with end stage liver failure underwent LDLT with microvascular hepatic artery anastomosis. The commonest etiology for liver failure was biliary atresia (63%). A total of 83 end to end hepatic artery anastomoses were completed using an operating microscope. Hepatic artery complications occurred in 5 patients, consisting of 3 cases of kinked anastomoses that were revised without complications and 2 cases of hepatic artery thrombosis (3%), of which one resulted in graft loss and patient death. Patient survival was 94% at 1 year and 90% at 5 years. Conclusions: Microvascular hepatic artery anastomosis in pediatric patients undergoing LDLT is associated with a low hepatic artery complication rate and excellent long-term liver graft function. Collaboration between microsurgeons and transplant surgeons can significantly reduce technical complications and improve patient outcomes. Financial Disclosure Statement: none Presented at the 2017 Annual Meeting of the American Society of Reconstructive Microsurgery in Waikoloa, HI, USA, January 14-17, 2017 and the 71st Annual Meeting of the Canadian Society of Plastic Surgeons in Winnipeg, MB, Canada, June 20-24, 2017. Corresponding Author: Dr. Ronald M. Zuker MD, FRCS(C), FACS, FAAP, Professor, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children , 555 University Avenue, Toronto, ON M5G 1X8, Phone: 416-813-6447, Fax: 416-813-6147, E-mail: ronald.zuker@sickkids.ca ©2018American Society of Plastic Surgeons

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