LAUSR

Variations in graft arterial anatomy can increase the risk of postoperative hepatic arterial thrombosis (HAT), especially in presence of a replaced or accessory right hepatic artery (RHA). We retrospectively analysed 223 cases of liver transplantations with the presence of a RHA on the graft. Patient outcomes were compared according to the 4 different reconstruction methods used: i)the re-implantation of the RHA into the splenic or gastroduodenal artery (n=106); ii)the interposition of the superior mesenteric artery (SMA) (n=83); iii)dual anastomosis (n=24); iv)use of an aortic patch including the origins of both the SMA and the coeliac trunk (n=10). A competing risk analysis and Inverse Probability Weighting(IPW) were used. We found that the interposition of the SMA method was associated with a significantly lower incidence of HAT, at 4.8% compared to the re-implantation method at 17.9%, dual anastomosis at 12.5% and aortic patch at 20%, p=0.03. In the competing risk analysis with IPW, the only risk factor for RHA thrombosis was the type of reconstruction. Taking the SMA interposition group as the reference, the sub-hazard ratio (sHR) was 5.05 (CI95[1.72 ; 14.78], p<0.01) for the re-implantation group, sHR=2.37 (CI95[0.51 ; 11.09], p=0.27) for the dual anastomosis group and sHR=2.24 (CI95 [0.35 ; 14.33], p=0.40) for the aortic patch group. There were no differences for intraoperative transfusion, hospitalization duration (p=0.37) or incidence of severe complications (p=0.1). The long-term graft (p=0.69) and patient (p=0.52) survival was not different. In conclusion, the SMA interposition method was associated with a lower incidence of RHA thrombosis.