| Objective:Liver transplantation is one of the effective treatments for end-stage liver diseases.However,postoperative arterial complications are always been an serious challenge for liver transplant recipients and clinicians.Some studies had found that the anatomical variation of the hepatic artery of the donor liver would be a major factor causing artery related complications after liver transplantation.The complex anatomical variation of the hepatic artery of the donor liver will significantly increase the difficulty of artery formation and reconstruction during the operation,which is a high risk factor for hepatic artery thrombosis.Although it is generally accepted that the reconstruction of hepatic artery should be the formation of donor recipient hepatic artery without lengthy and tension,there is no literature to confirm the advantages of this ideal arterial reconstruction.This article studied the influence of variation and reconstruction methods of donor hepatic artery on arterial complications after liver transplantation,evaluated the importance of color Doppler ultrasound in early detection and diagnosis of arterial complications,summarized and shared the anatomical types of variation of donor hepatic artery and the experience of intraoperative arterial reconstruction in our center.Methods:The clinical data of 415 patients with liver transplantation from January 2015 to April 2019 were reviewed.415 cases of donor hepatic artery anatomical types were summarized by Hiatt classification.According to whether existed arterial variation,they were divided into variation group and normal group.According to the difference of anastomotic site and number of Anastomotic stoma,the effects of different reconstruction methods on postoperative arterial complications were analyzed.ROC curve was used to analyze the PSV and RI values of color Doppler ultrasound on the first day after operation,and to evaluate the value of ultrasound in predicting postoperative arterial complications.Results:It was identified normal hepatic arterial anatomy in 347 donors(83.6%),and there were some variation in the others(16.4%).According to Hiatt classification,347 cases,9cases,43 cases,7cases and 9 cases respectively belonged to type I(83.6%),type II(2.2%),type III(10.4%),type IV(1.7%)and type V(2.2%).11 patients(2.7%)occurred arterial complication,including 5 patients(7.4%)in the variant group and 6 patients(1.7%)in the normal group.The incidence between the two groups existed statistical difference(c~2=4.96,P<0.05).3 cases(6%)with complex artery reconstruction occurred arterial complication and 8 cases(2%)with simple artery reconstruction occurred arterial complication.This difference is no statistical significance(P=0.13);Receiver operating characteristic(ROC)curve analyzed that the sensitivity and specificity respectively were72.7%,81.8%,72.7%,and 71.8%,48.9%,85.1%to take hepatic artery diameter≤0.31cm,PSV of≤58.1cm/s and RI≤0.6 as threshold to predict artery complications,with AUC value of hepatic artery diameter,PSV and RI were 0.752(95%CI:0.588-0.917),0.635(95%CI:0.481-0.790)and0.794(95%CI:0.643-0.945),respectively.Conclusion:The variation of donor hepatic artery will increase the risk of arterial complications after transplantation,but different reconstruction methods will not impact the postoperative arterial complications.The general principle of hepatic artery reconstruction is to select the donor and recipient hepatic artery with matching artery diameter as far as possible,so as to facilitate the arterial reconstruction of surgical operation,avoiding angulation,distortion and intimal injury,and ensure that the new hepatic artery has sufficient blood supply.End to end anastomosis of donor and recipient hepatic arteries is recommended for arterial reconstruction,which is more suitable for normal anatomical structure.Postoperative color Doppler ultrasound has important clinical significance for timely detection and diagnosis of arterial complications. |
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