Impact and Consequences of Recipient Gastroduodenal Artery (GDA) Ligation Prior to Hepatic Artery (HA) Anastomosis During Orthotopic Liver Transplantation (OLT).

Introduction: In Orthotopic Liver Transplantation, the recipient GDA is often ligated for the HA anastomosis. It is done either to gain mobility, length on recipient HA or in support of the hypothesis that it would prevent “Steal syndrome” protecting the anastomosis. The aim of study is to evaluate its impact on prevention of HA thrombosis (HAT) and consequences of such ligation. Methods: A retrospective analysis of cadaveric OLT (n=210) performed at a tertiary care center between 2016 and 2020 comparing the cases where recipient GDA was ligated (Group 1) or not (Group 2). Impact was evaluated by occurrence of HAT and consequences by post-operative hyperamylasemia (POHA), nausea and vomiting and delayed feeding. Result: Group 1 included 78 (37%) cases where common HA was used for anastomosis Group 2 had 132 (63%) cases where right HA or the proper HA was used for anastomosis. Presence or absence of a replaced/accessory vessel is indicated in the Table. Tabled 1Replaced/AccessoryRightLeftNoneGroup 111(14%)6(7.6%)59(75.6%)Group 217(12.8%)12(9%)102(77%) Open table in a new tab There was no incidence of hepatic artery thrombosis(HAT) reported in either group. In Group1, 31 out of 78(39.7%) patients were reported to have post-operative hyperamylasemia(POHA) ranging between 200 and 4700 Units/liter accompanied by delayed feeding, whereas in Group 2, 16 out of 132(12%) patients had POHA ranging between 200-1400 Units/liter (p value of <0.01 using Fisher’s exact test). Conclusion: Ligation of recipient GDA is not associated with decreased risk of HAT as compared to non-ligation. However, it does have consequences in the form of possible POHA leading to delayed feeding due to decreased oral tolerance.