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Impact of Extra-anatomical Hepatic Artery Reconstruction During Living Donor Liver Transplantation on Biliary Complications and Graft and Patient Survival

Rhu, Jinsoo MD1; Kim, Jong Man MD, PhD1; Choi, Gyu-Seong MD, PhD1; David Kwon, Choon Hyuck MD, PhD1; Joh, Jae-Won MD, PhD1

doi: 10.1097/TP.0000000000002601
Original Clinical Science—Liver
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Background. This study was designed to analyze the feasibility of extra-anatomical hepatic artery (HA) reconstruction in living donor liver transplantation (LT).

Methods. Patients who underwent their first living donor LT at our center between January 2008 and December 2017 were reviewed. HA reconstruction was classified as anatomical or extra-anatomical reconstruction (EAR). We compared the background characteristics and posttransplantation outcomes, including complications, biliary complications, graft survival, and overall survival. The potential risk factors for bile leakage were analyzed using multivariable logistic regression, while risk factors for biliary stricture-free survival, graft survival, and overall survival were analyzed using multivariable Cox regression.

Results. Among 800 patients, 35 (4.4%) underwent EAR, of whom 7 (7/35, 20.0%) experienced HA complications after the initial anatomical reconstruction and required EAR during reoperation. Patients who underwent EAR (n = 2/35, 5.7%) had a similar rate of HA complications compared with those who underwent anatomical reconstruction (n = 46/772, 5.9%, P = 0.699). EAR was a significant risk factor for bile leakage (odds ratio [OR], 4.167; 95% confidence interval [CI], 1.928-9.006; P < 0.001) along with multiple bile ducts (OR, 1.606; 95% CI, 1.022-2.526; P = 0.040) and hepaticojejunostomy (OR, 4.108; 95% CI, 2.190-7.707; P < 0.001). However, EAR had no statistical relationship to biliary stricture-free survival (hazard ratio [HR], 1.602; 95% CI, 0.982-2.613; P = 0.059), graft survival (HR, 1.745; 95% CI, 0.741-4.109; P = 0.203), or overall survival (HR, 1.405; 95% CI, 0.786-2.513; P = 0.251). HA complications were associated with poor biliary stricture-free survival (HR, 2.060; 95% CI, 1.329-3.193; P = 0.001), graft survival (HR, 5.549; 95% CI, 2.883-10.681; P < 0.001), and overall survival (HR, 1.958; 95% CI, 1.195-3.206; P = 0.008).

Conclusion. Extra-anatomical HA reconstruction during living donor LT was not a risk factor for biliary stricture, graft failure, or overall survival.

1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Received 29 August 2018. Revision received 30 October 2018.

Accepted 4 December 2018.

The authors declare no funding or conflicts of interest.

J.R. participated in the research design, research conduction, manuscript writing, and data analysis. J.M.K. participated in the research design, research conduction, and manuscript writing. G.S.C. participated in the research design, research conduction, and manuscript writing. C.H.D.K. participated in the research design, research conduction, and manuscript writing. J.-W.J. participated in the research design, research conduction, and manuscript writing.

Correspondence: Jong Man Kim, MD, PhD, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. (yjongman21@gmail.com).

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