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J Reconstr Microsurg 2022; 38(04): 306-312
DOI: 10.1055/s-0041-1732349
Original Article

Microscope-Assisted Arterial Anastomosis in Adult Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Outcomes

Peggy J. Ebner
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Katherine J. Bick
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Juliet Emamaullee
2   Keck School of Medicine, University of Southern California, Los Angeles, California
3   Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
,
Eloise W. Stanton 
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Daniel J. Gould
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Ketan M. Patel
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Yuri Genyk
2   Keck School of Medicine, University of Southern California, Los Angeles, California
3   Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
,
Linda Sher
2   Keck School of Medicine, University of Southern California, Los Angeles, California
3   Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
,
Joseph N. Carey
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
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Abstract

Background Living donor liver transplantation (LDLT) has expanded the availability of liver transplant but has been associated with early technical complications including the devastating complication of hepatic artery thrombosis (HAT), which has been reported to occur in 14% to 25% of LDLT using standard anastomotic techniques. Microvascular hepatic artery reconstruction (MHAR) has been implemented in an attempt to decrease rates of HAT. The purpose of this study was to review the available literature in LDLT, specifically related to MHAR to determine its impact on rates of posttransplant complications including HAT.

Methods A systematic review was conducted using PubMed/Medline and Web of Science. Case series and reviews describing reports of microscope-assisted hepatic artery anastomosis in adult patients were considered for meta-analysis of factors contributing to HAT.

Results In all, 462 abstracts were screened, resulting in 20 studies that were included in the meta-analysis. This analysis included 2,457 patients from eight countries. The pooled rate of HAT was 2.20% with an overall effect size of 0.00906.

Conclusion Systematic literature review suggests that MHAR during LDLT reduces vascular complications and improves outcomes posttransplant. Microvascular surgeons and transplant surgeons should collaborate when technical challenges such as small vessel size, short donor pedicle, or dissection of the recipient vessel wall are present.

Keywords

liver transplantation - microsurgery - consultants

Note

This study was conducted at Keck Hospital of University of Southern California, Los Angeles, CA.




Publication History

Received: 25 January 2021

Accepted: 31 May 2021

Article published online:
24 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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