Hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor

Objective To explore the clinical and technical essentials of hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor. Methods The clinical data were retrospectively analyzed for 15 pediatric deceased donor aged 4.6-16.3 years undergoing split liver transplantation from July 2017 to March 2019. The donors were DBD (donation after brain death, n=13) and DCD(donor after cardiac death, n=2). Thirty split liver transplantations were performed using these 15 pediatric deceased donors. The receptors were adult + child (n=5) and child + child recipients (n=10). According to the Michels’ classification, the clinical types were I (n=13), V (n=1) and VI (n=1). Hepatic arterial segmentation: In type I hepatic arterial type donor liver, proper hepatic artery was retained in right trilobar liver (n=8), low-age (< 7 years) donor liver (n=5), retaining proper hepatic artery in left liver & reconstructing right trilobe directly using right hepatic artery trunk (n=4). Methods of hepatic artery reconstruction: 8-0 Prolene string was utilized under 4.5 times magnifying glass for reconstructing hepatic artery in recipients aged under 4 years. Results Hepatic arterial segmentation and reconstruction were successfully completed. Hepatic arterial thrombosis occurred in 2./25 ecipients. The overall incidence of hepatic arterial complications was 6.67%. Conclusions For reducing the occurrence of arterial complications, arterial segmentation and reconstruction in pediatric deceased donor should be performed according to the size of donor liver and the characteristics of hepatic arterial classification. Key words: Liver transplantation; Hepatic artery; Complication