Arterial Reconstruction Using the Right Gastroepiploic Artery in Living Donor Liver Transplantation: A Single-Center Experience.

Abstract

BACKGROUND Recipient hepatic arteries are generally used for arterial reconstructions in living donor liver transplantation. When the hepatic arteries are not feasible, the right gastroepiploic artery is one of the options for arterial reconstructions. In this study, we evaluate the feasibility of using the right gastroepiploic artery and report the analyzed retrospective patient outcomes. MATERIAL AND METHODS We included 324 patients who underwent primary living donor liver transplantation between August 1997 and December 2023. The rates of complications and surgical outcomes for different arteries used for reconstruction were compared between the groups. RESULTS For primary arterial reconstruction, the right gastroepiploic artery was used in 18 patients. The incidence of arterial complications and biliary strictures was higher than in the remaining 306 patients (P=0.01 and P=0.21, respectively). The 1-year and 5-year graft survival rates were 83.3% and 77.8% in the right gastroepiploic artery group, and 83.7% and 70.1% in the hepatic artery group, respectively (P=0.58). Eleven patients underwent arterial re-reconstruction secondary to arterial complications. The right gastroepiploic artery was used for the first time in 7 of these patients because the hepatic arteries were not reusable. Arterial complications after arterial re-reconstruction occurred in 4 patients (36.4%). CONCLUSIONS Arterial reconstruction using the right gastroepiploic artery was an effective option when the hepatic arteries were not suitable options, as it offered graft outcomes comparable to those of hepatic artery reconstruction, despite an increased risk of arterial and biliary complications.