Ex situ arterial reconstruction prior normothermic machine perfusion of liver grafts

Autor: Felix Becker, Felicia Kneifel, Arne Riegel, Shadi Katou, Tristan Wagner, Isabelle Flammang, Mazen Juratli, Thomas Vogel, Sonia Radunz, Haluk Morgul, Andreas Pascher, Philipp Houben, Jens G. Brockmann
Rok vydání: 2022
Předmět:
Zdroj: Langenbeck's Archives of Surgery. 407:3833-3841
ISSN: 1435-2451
DOI: 10.1007/s00423-022-02611-8
Popis: Purpose Atypical variants of the hepatic artery are common and pose a technical challenge for normothermic machine perfusion (NMP). The transplant surgeon has three options when confronted with hepatic arterial variation in a liver graft to be subjected to NMP: to perform arterial reconstruction (i) prior, (ii) during, or (iii) following NMP. Methods Herein, we report our experience and technical considerations with pre-NMP reconstruction. Out of 52 livers, 9 had an atypical hepatic artery (HA): 3 replaced right HA, 3 replaced left HA, 1 accessory left HA, 1 accessory left and right HA, and 1 replaced left and right HA. Results Reconstruction was conducted during back-table preparation. A single vascular conduit was created in all grafts to allow single arterial cannulation for NMP, necessitating only one arterial anastomosis within the recipient. All grafts were subjected to NMP and subsequently successfully transplanted. Conclusion Our approach is being advocated for as it preserves the ability to alter the reconstruction in case of problems resulting from the reconstruction itself, thereby allowing functional evaluation of the reconstruction prior transplantation, permitting simultaneous reperfusion in the recipient, and providing the shortest possible duration for vascular reconstruction once the graft is rewarming non-perfused within the recipient. In addition, in light of the frequency of technically demanding reconstructions with very small vessels, we consider our technique beneficial as the procedure can be performed under ideal conditions at the back-table.
Databáze: OpenAIRE