The impact of extra-anatomical hepatic artery reconstruction during living donor liver transplantation on biliary complications and graft and patient survival

Background: This study was designed to analyze the feasibility of extra-anatomical hepatic artery reconstruction in living donor liver transplantation. Methods: Patients who underwent their first living donor liver transplantation at our center between January 2008 and December 2017 were reviewed. Hepatic artery reconstruction was classified as anatomical or extra-anatomical reconstruction. We compared the background characteristics and post-transplantation outcomes, including complications, biliary complications, graft survival, and overall survival. The potential risk factors for bile leakage was analyzed using multivariable logistic regression while risk factor for biliary stricture-free, graft, and overall survival were analyzed using multivariable Cox regression. Results: Among 800 patients, 35 (4.4%) underwent extra-anatomical reconstruction while seven patients (7/35, 20.0%) experienced hepatic artery complications after the initial anatomical reconstruction and required extra-anatomical reconstruction during reoperation. Patients who underwent extra-anatomical reconstruction (n = 2/35, 5.7%) had a similar rate of hepatic artery complications compared to those who underwent anatomical reconstruction (n = 46/772, 5.9%, P = 0.699). Extra-anatomical reconstruction was a significant risk factor of bile leakage (OR = 4.167, CI = 1.928-9.006, P

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