Reconstruction of all hepatic arteries in right lobe grafts with two hepatic arteries and zero percent hepatic artery thrombosis.

Hepatic artery thrombosis (HAT) is a common cause of graft loss in living-donor liver transplantation (LDLT), occurring in approximately 2.5-8% of patients. Some right lobe grafts have two hepatic arteries (HAs), and the optimal reconstruction technique remains controversial. This study aimed to identify risk factors for HAT and to evaluate the efficacy of reconstructing two HAs in right lobe grafts. This retrospective, single-center study analyzed 1,601 LDLT recipients with a right liver graft and divided them into one HA (n=1,524) and two HA (n=77) groups. The reconstruction of all HAs was performed using a microscope with an interrupted suture. The primary outcome was any HAT event. Of the 1,601 patients, 37.8% had a history of transcatheter arterial chemoembolization (TACE), and 130 underwent pretransplant hepatectomy. Extraanatomical arterial reconstruction was performed in 38 cases (2.4%). HAT occurred in 1.2% of patients (20/1601) who underwent surgical revascularization. In the multivariate analysis, undergoing pretransplant hepatectomy (p=0.008), having a female donor (p=0.02), having smaller graft-to-recipient weight ratio (GRWR) (p=0.002), and undergoing extraanatomical reconstruction (p=0.001) were identified as risk factors for HAT. However, having two HA openings in right liver grafts was not a risk factor for HAT in our series. Kaplan-Meier survival analysis showed no significant difference in graft survival and patient survival rates between the one HA and two HA groups (p=0.09, p=0.97). In our series, although the smaller HA in the two HA group should increase the risk of HAT, HAT did not occur in this group. Therefore, reconstructing both HAs when possible may be a reasonable approaches in LDLT using a right liver graft with two HA openings.