Abstract

Background: Our aim was to report a single centre experience of using a recipient’s aberrant right hepatic artery (RHA) from the superior mesenteric artery (SMA) to establish inflow into liver allografts.
Material/Methods: All patients who had arterial reconstruction with an aberrant RHA were identified from a prospective database (1989-2004). Indications and outcomes were evaluated, with particular reference to arterial complications.
Results: An aberrant RHA was used in 27/2518 recipients (1%), including 6 paediatric recipients. Indications were replaced CHA (4), hypoplastic CHA (7), atheroma (12), previous conduit (1) and poor post-anastomotic flow (3). After a median of 42 months, arterial complications occurred in 2 paediatric recipients (hepatic artery thrombosis 1; arterial stenosis 1). Four patients developed anastomotic biliary strictures, and one paediatric recipient developed ischaemic cholangiopathy after hepatic artery thrombosis. Two patients underwent retransplantation (one patient with arterial stenosis). 1-year and 5-year patient survival rates were 85% and 81%. There were 6 deaths unrelated to vascular complications.
Conclusions: In adult liver transplant recipients with an unsuitable common hepatic artery, an aberrant right hepatic artery may be used to establish arterial inflow. This technique may be associated with a higher rate of vascular complications in paediatric recipients, and should be used cautiously in this group.

Keywords: Liver Transplantation, replaced right hepatic artery, accessory right hepatic artery, steal syndrome, hepatic artery thrombosis