Reconstruction of Type V Hepatic Arterial in the Adult and Pediatric Liver Transplant Recipient

The replaced common hepatic artery (RCHA) is an uncommon arterial anomaly that, when present, makes hepatic arterial reconstruction during liver transplantation technically challenging. At our institution, the reconstruction of the recipient RCHA consists of 2 techniques that include either an infrarenal donor iliac artery aortic conduit or a direct donor celiac trunk anastomosis to the proximal RCHA. Our experience demonstrates that the direct anastomosis to the RCHA provides a reliable source of arterial inflow, allows preservation of the recipient arterial anatomy, and minimizes the dissection required to create an infrarenal aortic conduit. Between September 1998 and April 2019, we performed 1782 liver transplants (1230 adults, >18 years; 552 pediatric, <18 years). There were 36 (2.92%) adult and 20 (3.07%) pediatric liver transplant recipients that possessed a RCHA. Allograft and patient survivals were 94.70% and 94.10%, in both the infrarenal conduit and direct Type-V anastomosis cohorts at 1 year, respectively. To date, hepatic artery thrombosis (HAT) has not occurred in the 2 cohorts of pediatric transplant recipients. In conclusion, the direct donor celiac trunk to RCHA anastomosis is a safe and effective way to perform arterial reconstruction with low hepatic artery thrombosis and biliary complication rates.