LAUSR

O study included 800 living donor liver transplantations, 35 (4.4%) of which underwent extra-anatomical reconstruction (EAR). As indicated by this small number of cases, EAR is not a preferred method. During living donor liver transplantation, the best option is using branches of the hepatic artery, which enables the easiest and safest reconstruction with regard to length, width, and course of the inflow. Nevertheless, there are situations in which AR is not feasible, and EAR is 1 alternative. The purpose of this study was to analyze the impact of EAR. By carefully reviewing our data and adjusting for confounding factors, we showed that performing EAR when AR is not feasible does not add risk for the recipient. Instead, our data demonstrated that hepatic artery complications are the main risk, and if the surgeon can avoid hepatic artery complications, EAR is safe and feasible for the recipient. In fact, there were no differences in hepatic artery complications after EAR compared with AR (P = 0.699). However, more patients experienced hepatic artery complications in the EAR group (P < 0.001) since 7 patients who experienced complications after AR were included in the EAR group. Multivariable analysis showed that biliary stricture-free (P = 0.059), graft (P = 0.203), and overall survival (P = 0.251) were similar, while the occurrence of hepatic artery complications was associated with biliary stricture-free (P = 0.001), graft (P < 0.001), and overall survival (P = 0.008). Regarding the perfusion of the end arterioles of the bile duct on both the graft and recipient side, the key is not to compromise inflow to the pericholedochal arteries. Performing AR using the right, middle, or left hepatic artery will not provide additional benefit for the bile duct opening on the graft side if EAR can supply