Microsurgical consideration in the liver transplantation from living related donor.

Han, Sang Hoon; Nam, Sang Jae; Park, Sang Hoon; Koh, Kyoung Suk; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 1998;25(5):921-927.
Published online July 1, 1998.

Microsurgical consideration in the liver transplantation from living related donor.

Sang Hoon Han, Sang Jae Nam, Sang Hoon Park, Kyoung Suk Koh, Sung Gyu Lee, Young Joo Lee, Kwang Min Park

Abstract

Living-Related-Liver-Transplantation(LRLT) has been established as a reliable method of treatment for patients with end-stage liver disease when the scarcity of cadaveric organ donor was considered. But the hepatic artery is high at risk in thrombosis(HAT) following LRLT. So microsurgical technique was introduced in anastomosis of hepatic artery. This study was aimed at using microsurgical technique in LRLT and presenting some technical details of the procedures. From December 1994 to November 1997, a sereis of 41 LRLTs on patients with end-stage liver disease was performed with follow-up period of 5 to 40 months(mean,15.6 months). Organs were donated by living-related donors(n=36) and living-nonrelated ones(n=5). Hepatic artery was reconstructed with microsurgical technique by plastic surgeon. All hepatic arteries were patent intraoperatively and postoperatively except one case, which had leakage at anastomosed site on the postoperative fourth day.Hepatic artery is high at risk in thrombosis(HAT) following LRLT due to the caliber discrepancy and technical difficulties. To overcome these risks, microsurgical technique was introduced. The technique has greatly reduced arterial complication. However, there are some difficulties in microsurgery of LRLT, which are somewhat different from those in other microsurgery fields: the first difficulty is to obtain a good operative field and a sufficient view through the microscope. The second one is to overcome arterial caliber discrepancy. And the last is to achieve a stable posture in narrow and deep operating field against the respiratory movement and heartbeat.With the persistent team approach of plastic and general surgeons in the field of LRLT, we could have reduced the HAT and have had better outcome after LRLT.

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