Effect Of Hepatic Artery Reconstruction Techniques On Prognosis Of Liver Transplantation

Objective Solid organ transplantation technology has completely changed the treatment of patients with end-stage organ failure,among which the development of liver transplantation technology is particularly significant,and the quality of life and survival time of millions of patients with end-stage liver diseases and hepatocellular carcinoma have been improved,and liver transplantation has become the only treatment for end-stage liver diseases.Vascular reconstruction technology is the key link of successfully liver transplantation,perioperative vascular complications of liver transplantation can lead to graft loss and recipient death,among which hepatic artery complications are more common.Therefore,this article discussed the impact of different reconstruction methods of hepatic artery on postoperative hepatic artery complications and the prognosis of recipients.Method Clinical data of 140 liver transplant recipients were retrospectively analyzed.All recipients were divided into the conventional hepatic artery reconstruction group(n=123)and special hepatic artery reconstruction group(n=17)according to different reconstruction methods of the hepatic artery.Comparing the clinical indexes of donors,and preoperative,intraoperative and postoperative liver function and hemostasis function of recipients,postoperative hepatic artery complication’s incidence and survival rate of recipients between two groups.Result There were no significant differences in sex,age,weight,body mass index(BMI),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and serum sodium ion concentration(Na~+)of donors between two groups(all P>0.05).The ALT and AST levels at postoperative 1d,total bilirubin(TBIL)at postoperative 7d and prothrombin time international normalized ratio(PT-INR)at postoperative 30d in special hepatic artery reconstruction group were higher than those in the conventional hepatic artery reconstruction group,and the differences were statistically significant(P=0.04,0.04,0.01,0.03).There were no significant differences in the operation time,anhepatic phase,intraoperative blood loss,intraoperative transfusion volume of red blood cells,cold or warm ischemia time,the length of intensive care unit(ICU)stay,the length of hospital stay,the peak systolic velocity(PSV)and resistance index(RI)measured by Doppler Ultrasonography(DUS)at postoperative 1d and 7d,the blood concentration of tacrolimus(Tac)at postoperative 3,7,14,28d between two groups(all P>0.05).In the conventional hepatic artery reconstruction group,5 recipients developed hepatic artery complications,namely diffusing acute hepatic artery thrombosis(HAT),the rupture of pseudoaneurysm at the anastomosis of the hepatic artery,the stump pseudoaneurysm of gastroduodenal artery(GDA)ruptures into the duodenal bulb,the rupture of the donor hepatic artery,rupture at the anastomosis of hepatic artery,whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group,with no significant difference between two groups(P>0.05).In the special hepatic artery reconstruction group,the 1-,3-and 5-year cumulative survival rates were equally 82.4%,compared with 85.0%,78.9%,and 75.6%in the conventional hepatic artery reconstruction group respectively.There was no significant difference between two groups(all P>0.05).Conclusions When hepatic artery variations and(or)lesions are detected in donors and recipients,the use of special hepatic artery reconstruction may effectively restore the hepatic arterial blood flow of liver allograft after liver transplantation,it may affect the recovery of short-term liver function and hemostasis/coagulation function in liver transplant recipients but will not affect the incidence of hepatic artery complications and survival rate of the recipients following liver transplantation.