Impact of Variant Donor Hepatic Arterial Anatomy on Clinical Graft Outcomes in Liver Transplantation

Standard hepatic arterial anatomy is composed of the common hepatic artery proceeding from the celiac trunk and giving rise to the gastroduodenal artery (GDA) and proper hepatic arteries. Reconstruction of the hepatic arterial supply during liver transplantation, often complex in nature, can be required in cases of accessory or replaced vessels. A recent review summarized the hepatic arterial anatomy reported in over 19,000 cases from 20 individual studies. (1) It has been suggested that the presence of nonstandard donor arterial anatomy may be related to an increased incidence of hepatic artery thrombosis (HAT).(2) Although the overall incidence of HAT is low, it can have devastating effects, including the need for retransplantation, long-term biliary complications, and increased patient mortality. This article describes the arterial anatomy in a large number of liver transplants, with routine anastomosis of a very short hepatic artery and routine reconstruction of the accessory right hepatic artery to the GDA. Study outcomes include incidence of HAT within 30 days of transplant, early graft loss up to 1 year after transplant, and 10-year graft survival