Sağ lob canlı verici karaciğer nakli alıcılarında hepatik arter çeşidi ve sayısının safra komplikasyonları üzerine etkileri: hepatik arter trombozu olmaksızın tek merkez deneyimi

Yıl 2024, Cilt: 17 Sayı: 4, 674 - 680, 09.10.2024

Ender Anılır , Feyza Sönmez Topcu , Alihan Oral , Emrah Sahın , Abuzer Dirican , Bülent Ünal

https://doi.org/10.31362/patd.1449072

Öz

Amaç: Hepatik arter, grefte ait safra yollarının kanlanmasını sağlar. Nakil sonrası dönemde oluşabilecek safra komplikasyonlarının nedenlerinden biri de alıcının hepatik arterindeki sorunlar olabilir. Alıcı hepatik arterin tipine ve sayısına göre nakil sonrası safra komplikasyonlarının etkisini inceledik.
Gereç ve Yöntem: Çalışmaya, son dönem karaciğer sirozu nedeniyle sağ lob LDLT uygulanan 18 yaş üstü 185 hasta dahil edildi. Alıcının greft arterine anastomoz yapılan sağ hepatik arter (RHA), sol hepatik arter (LHA), propria hepatik arter (PHA) ve ana hepatik arter (CHA) ve sağ ve sol hepatik arterlerden oluşan çift hepatik arter anastomozları incelendi. Biliyer komplikasyonlar tek veya çift arter anastomozu ve sağ veya diğer hepatik arterlerle anastomoz yapılması açısından istatistiksel olarak analiz edildi.
Bulgular: Tek ve çift arter anastomozları arasında safra kanalı darlığı veya sızıntısı açısından istatistiksel olarak anlamlı fark yoktu (p=0,767). Safra yolu komplikasyonu olan ve olmayanlar arasında arter seçiminin değerlendirilmesinde RHA, LHA, PHA, CHA ile tek ve çift arterler arasında istatistiksel olarak anlamlı fark gözlenmedi (p=0,445).
Sonuç: Alıcılarda anastomozda kullanılan hepatik arter tipi ve sayısı sayısı safra yolu komplikasyon oranını değiştirmemektedir.

Anahtar Kelimeler

Hepatik arter, karaciğer, transplantasyon, safra, komplikasyon

Effects of hepatic artery type and number on bile complications in right lobe living donor liver transplant recipients: single center experience without hepatic artery thrombosis

Öz

Purpose: Hepatic artery provides blood supply to the biliary tract of the graft, one of the causes of the biliary complications that may occur in the post-transplant period may be the problems of the recipient's hepatic artery. We examined the effect of post-transplant biliary complications according to the type and number of recipient hepatic artery.
Materials and Methods: One hundred eighty five patients older than 18 years of age who underwent right lobe LDLT for end-stage liver cirrhosis were included in the study. The recipient's right hepatic artery (RHA), left hepatic artery (LHA), propria hepatic artery (PHA) and common hepatic artery (CHA), which were anastomosed to the graft artery and double hepatic artery anastomoses formed of the right and left hepatic arteries, were examined. Biliary complications were analyzed statistically in terms of single or double artery anastomosis and anastomoses with the right or the other hepatic arteries.
Results: There was no statistically significant difference between single and dual artery anastomoses in terms of bile duct stricture or leakage (p=0.767). No statistically significant difference was observed between RHA, LHA, PHA, CHA, and between single and dual arteries in the evaluation of artery selection between those with and without biliary tract complications (p=0.445)
Conclusion: Hepatic artery type selection and number of the recipient does not change the biliary tract complication.

Anahtar Kelimeler

Hepatic artery, liver, transplantation, bile, complication

Kaynakça

• 1. Balci D, Ahn CS. Hepatic artery reconstruction in living donor liver transplantation. Curr Opin Organ Transplant 2019;24:631-636. https://doi.org/10.1097/MOT.0000000000000697
• 2. Oberkofler CE, Reese T, Raptis DA, et al. Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease? Liver Transpl 2018;24:790-802. https://doi.org/10.1002/lt.25044
• 3. Koneru B, Sterling MJ, Bahramipour PF. Bile duct strictures after liver transplantation: a changing landscape of the Achilles’ heel. Liver Transpl 2006;12:702-704. https://doi.org/10.1002/lt.20753
• 4. Seo CH, Ahn J, You YK, Choi HJ. Single-center experience with hepatic artery reconstruction during living donor liver transplantation: microscope versus surgical loupe. Ann Transplant 2021;26:e933371-933377. https://doi.org/10.12659/AOT.933371
• 5. Noussios G, Dimitriou I, Chatzis I, Katsourakisb A. The main anatomic variations of the hepatic artery and their importance in surgical practice: review of the literature. J Clin Med Res 2017;9:248-252. https://doi.org/10.14740/jocmr2902w
• 6. Eleazar Chaib E, Kanas AF, Galvão FHF, Carneiro D'Albuquerque LA. Bile duct confluence: anatomic variations and its classification. Surg Radiol Anat 2014;36:105-109. https://doi.org/10.1007/s00276-013-1157-6
• 7. Hann A, Seth R, Mergental H, Hartog H, Alzoubi M, Stangou A. Biliary strictures are associated with both early and late hepatic artery stenosis. Transplant Direct 2021;7:e643. https://doi.org/10.1097/TXD.0000000000001092
• 8. Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World J Gastroenterol 2013;19:2841-2846. https://doi.org/10.3748/wjg.v19.i19.2841
• 9. Robert C Verdonk RC, Buis CI, Porte RJ, et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 2006;12:726-735. https://doi.org/10.1002/lt.20714
• 10. Matsuda H, Yagi T, Sadamori H, et al. Complications of arterial reconstruction in living donor liver transplantation: a single-center experience. Surg Today 2006;36:245-251. https://doi.org/10.1007/s00595-005-3131-3
• 11. Ng SW. Hepatic artery anastomosis in liver transplantation. Ann Acad Med Singap 2021;20:666-668. https://doi.org/10.47102/annals-acadmedsg.2021332
• 12. Piskin T, Demirbas T, Yalcin L, et al. Recipient splenic artery utilization for arterial re-anastomosis in living donor liver transplantation: single-center experience. Hepatogastroenterology 2012;59:1263-1264. https://doi.org/10.5754/hge11642
• 13. Herrero A, Souche R, Joly E, et al. Early hepatic artery thrombosis after liver transplantation: what is the ımpact of the arterial reconstruction type? World J Surg 2017;41:2101-2110. https://doi.org/10.1007/s00268-017-3989-4
• 14. Uchiyama H, Ikegami T, Soejima Y, et al. Use of recipient's left hepatic artery for artery reconstruction in right lobe living donor liver transplantation with duct-to-duct anastomosis. Transplantation 2010;89:1016-1021. https://doi.org/10.1097/tp.0b013e3181ce77c4
• 15. Zhao JC, Yan LN, Li B, et al. Hepatic arterial reconstruction and complications management in adult-to-adult living donor liver transplantation. Zhonghua Wai Ke Za Zhi 2008;46:166-169.
• 16. Fan ST, Lo CM, Liu CL, et al. Biliary reconstruction and complications of right lobe live donor liver transplantation. Ann Surg 2002;236:676-683. https://doi.org/10.1097/00000658-200211000-00019
• 17. Chikkala BR, Rahul R, Agarwal S, et al. Outcomes of right and left hepatic arterial anastomosis in right lobe living donor liver transplant. Exp Clin Transplant 2022;20:157-163. https://doi.org/10.6002/ect.2020.0309
• 18. Cakir T, Sabuncuoglu MZ, Soyer V, et al. Use of the Right Lobe Graft With Double Hepatic Arteries in Living-Donor Liver Transplant. Exp Clin Transplant 2022;20:495-499. https://doi.org/10.6002/ect.2015.0108
• 19. Lee KW, Sanghoon Lee S, Jeungmin Huh J, et al. Outcome of living donor liver transplantation using right liver allografts with multiple arterial supply. Liver Transpl 2016;22:1649-1655. https://doi.org/10.1002/lt.24600