J Reconstr Microsurg 2009; 25(7): 439-443
DOI: 10.1055/s-0029-1223853
© Thieme Medical Publishers

Hepatic Artery Microvascular Anastomosis in Pediatric Living Donor Liver Transplantation: A Review of 35 Consecutive Cases by a Single Microvascular Surgeon

Andre Panossian1 , Ivan Diamond2 , Annie Fecteau2 , David Grant2 , Ronald Zuker2
  • 1Children's Hospital Los Angeles–Plastic Surgery, Los Angeles, California
  • 2Hospital for Sick Children, Sick Kids Transplant Center Toronto, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
19 May 2009 (online)


Early experience with living donor liver transplantation (LDLT) was often complicated by hepatic artery thrombosis (HAT), a devastating complication resulting in graft loss. Attempting to reduce the incidence of HAT, we undertook a retrospective review of all children at our institution undergoing LDLT between March 2000 and August 2007, with the hepatic artery anastomosis performed by a single microvascular surgeon. Transplant surgeons performed the remainder of the operation. Patient outcomes were evaluated, including 1-year arterial and biliary complications, as well as overall survival. End-to-end hepatic arterial anastomoses were performed in 35 patients (median age: 15 months). Median posttransplant follow-up was 39 months (range: 0 to 90 months). One patient with a diffuse coagulopathy was retransplanted for HAT; this patient also demonstrated portal and hepatic vein thromboses. Biliary complications occurred in seven patients: three leaks, one cholangitis, one nonspecific dilatation, and two strictures. The median posttransplant follow-up was 39 months (range: 0 to 90 months). One- and 5-year patient survival was 94% and 94%, respectively. Very low rates of HAT can be achieved with LDLT using microsurgical techniques for hepatic arterial anastomoses. Outstanding long-term liver graft function can be achieved after LDLT when plastic surgeons and transplant surgeons collaborate together to reduce technical complications.


Andre Panossian, M.D. 

Children's Hospital Los Angeles–Plastic Surgery

4650 Sunset Blvd. MS #96, Los Angeles CA 90027

Email: apanossian@chla.usc.edu