Management of vascular complications in adult-to-adult living donor liver transplant recipients: A single-group experience with 1000 cases

Background
Liver transplantation is currently the method of choice for treatment of cases with irreversible severe liver dysfunction. In living donor liver transplantation (LDLT), vascular complications are more frequently encountered than in deceased donor transplantation. Satisfactory outcomes of liver transplantation are critically dependent on sufficient venous outflow and uncompromised inflow to the liver graft. The aim of this study was to discuss the complications of vascular reconstruction in our study cases and the different modalities of their management.
Patients and methods
This is a retrospective study evaluating vascular complications in adult-to-adult living donor liver transplant recipients that occurred in Ain Shams University Specialized Hospital and Wadi El-Neel Hospital from October 2001 to December 2020 and their management.
Results
The recipients comprised 819 males and 181 females. Pediatric cases were excluded from this study. The indications for liver transplantation were chronic hepatocellular liver diseases due to HCV infection in 48.8%, hepatocellular carcinoma in 33.9%, cryptogenic cirrhosis in 5.9%, fulminant hepatic failure in 0.3%, and other causes in 7.9%. Vascular complications were 9.5% (7.9% occurred during the first 3 months after transplantation and 1.6% occurred late after the first 3 months from transplantation). Hepatic artery complications were seen in 2.2%, portal vein complications were seen in 1.0%, hepatic vein complications were seen in 0.5%, whereas V5, V8, and the inferior right hepatic vein (Makuuchi) complications were seen in 5.8% of cases.
Conclusion
Careful preoperative assessment of both the recipient and the donor with proper intraoperative vascular reconstruction techniques with microsurgical technique ultimately prevents vascular complications. Routine posttransplant Doppler assessment should be performed at least once a day for the first week postoperatively. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be managed by means of interventional radiology in the form of balloon angioplasty and end-luminal stent to avoid late complications and mortality.