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Does Variant Hepatic Artery Anatomy in a Liver Transplant Recipient Increase the Risk of Hepatic Artery Complications After Transplantation?

Kousei Ishigami1, Yan Zhang1, Stephen Rayhill2, Daniel Katz2 and Alan Stolpen1

1 Department of Radiology, University of Iowa, Carver College of Medicine, 200 Hawkins Dr., 3885 JPP, Iowa City, IA 52242-1077.
2 Department of Surgery, University of Iowa, Carver College of Medicine, IA City, Iowa 52242-1077.



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  		Fig. 1A. —Surgical reconstruction of hepatic artery. Schematic of branch patch arterial anastomosis shows that in recipient, branch patch is formed at origin of gastroduodenal artery from common hepatic artery. In donor, branch patch is typically formed at origin of splenic artery from celiac trunk. RHA = right hepatic artery, LHA = left hepatic artery, GDA = gastroduodenal artery, PHA = proper hepatic artery, CHA = common hepatic artery, LGA = left gastric artery.

 


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  		Fig. 1B. —Surgical reconstruction of hepatic artery. Schematic shows that aortic jump graft typically consists of common and external iliac arteries from donor. One end of graft is joined to infrarenal abdominal aorta in recipient via end-to-side anastomosis; other end of graft is joined to hepatic artery of donor via branch patch anastomosis, as described in A.

 


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  		Fig. 2A. —57-year-old man with celiomesenteric trunk who developed hepatic artery thrombosis 132 days after liver transplantation. Oblique coronal targeted maximum-intensity-projection image from pretransplantation contrast-enhanced 3D MR angiography (TR/TE, 4.8/1.1; flip angle, 20°) shows celiac and superior mesenteric arteries (SMA) arising from common trunk (black arrow). White arrow indicates takeoff of gastroduodenal artery from common hepatic artery (CHA).

 


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  		Fig. 2B. —57-year-old man with celiomesenteric trunk who developed hepatic artery thrombosis 132 days after liver transplantation. Digital subtraction aortogram obtained after liver transplantation shows occlusion of hepatic artery (black arrow). White arrow indicates celiomesenteric trunk.

 


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  		Fig. 3A. —58-year-old man with replaced right hepatic artery who developed hepatic artery thrombosis 65 days after liver transplantation. Oblique coronal targeted maximum-intensity-projection image from pretransplantation contrast-enhanced 3D MR angiography (TR/TE, 4.8/1.1; flip angle, 15°) reveals right hepatic artery (arrow) arising from superior mesenteric artery.

 


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  		Fig. 3B. —58-year-old man with replaced right hepatic artery who developed hepatic artery thrombosis 65 days after liver transplantation. Selective digital subtraction angiogram of celiac trunk after liver transplantation shows occlusion of hepatic artery (arrow).

 


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  		Fig. 4A. —47-year-old man with replaced right hepatic artery from abdominal aorta who developed hepatic artery stenosis 107 days after liver transplantation. Oblique axial targeted maximum-intensity-projection image from pretransplantation contrast-enhanced 3D MR angiography (TR/TE, 4.2/0.9; flip angle, 20°) shows right hepatic artery (arrow) arising directly from abdominal aorta just below celiac trunk.

 


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  		Fig. 4B. —47-year-old man with replaced right hepatic artery from abdominal aorta who developed hepatic artery stenosis 107 days after liver transplantation. Conventional angiogram of common hepatic artery after liver transplantation shows high-grade stenosis at arterial anastomosis (white arrow). Pigtail catheter (black arrow) was placed to drain liver abscess.

 

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