Evaluation of the Impact of Dissection vs Non-dissection of Right Hepatic Artery from Recipient Bile Duct on the Biliary Anastomosis in Post-living Donor Liver Transplantation, A Retrospective Comparative Study
Authors: Abd-elbasset Hany saied , Elsaid Kamal Mamdouh , Elgazar Amr Emam , Ali Fahmy Ahmed adel 
Published: November 2024

Abstract

Background
Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease and with acute liver failure and it is associated with excellent outcomes and survival rates at 1 and 5 years. The incidence of biliary complications (BCs) after liver transplantation is reported to range from 5% to 20%, most of them occurring in the first three months, although they can occur also several years after transplantation. Biliary complications occur more frequently after living donor liver transplantation (LDLT) versus deceased donor liver transplantation, and they remain the most common and intractable problems after LDLT. The anatomical limitations of multiple tiny bile ducts and the differential blood supplies of the graft ducts may be significant factors in the pathophysiological mechanisms of biliary complications in patients undergoing LDLT.

Objective
The aim of this study was to determine if non-dissection of RHA and use of LHA in arterial reconstruction lowers the risk of post-operative biliary complications.

Patients and Methods
It is a retrospective comparative study which carried out at the liver transplant unit at Ain Shams Specialized hospital and at Cairo Fatemic Hospital. The study was on patients who had undergone liver transplantation from June 2016 to June 2022 with sample size 100 patients and follow up of the patients for one year, They were divided into two group: group (A) included 50 recipients who had LHA for arterial reconstruction and group (B) included 50 recipients who had RHA for arterial reconstruction.

Results
There were 100 patients had been selected for our study, the patients were divided into two equal groups: group (A) LHA reconstruction group and group (B) RHA reconstruction group where the occurrence of biliary complications were compared between group (A) and group (B). Our study had shown that the patients complain of biliary leakage in group (A) were 11 (22%) against 8 (16%) in group (B), also patients complain of BAS were 12 (26%) in group (A) compared to 10 (20%) in group (B), while patients complain of combined leakage and biliary anastomotic stricture were 3 (6%) compared to 1 (2%) in group (B) but there was no statistical significant difference between both groups.

Conclusion
In conclusion, there is no significant difference in using the recipient’s left hepatic artery (LHA) over the right hepatic artery (RHA) for the arterial reconstruction in right lobe LDLT. There are many other factors that affect biliary anastomosis and may lead to biliary complications need to be approached systematically to reduce all risk factors as number of graft ducts, ductoplasty, cold ischemia and as well as arterial reconstruction. In addition, further studies are needed to definitively identify the different risk factors and improve the outcome of this procedure and reduce the complications.