Distal gastroduodenal arterial inflow as a salvage strategy for extensive intraoperative arterial dissection in living donor liver transplantation.

We read with great interest the study by Cherukuru and colleagues, demonstrating utility of distal gastroduodenal artery (GDA) for salvage arterial inflow in living donor liver transplantation (LDLT).1 Recipient arterial dissection is a formidable event in LDLT and has the potential to alter the course of a well planned transplant procedure. Our experience resonates well with the findings of the current study. In over 950 LDLTs including 40 patients requiring extra anatomic inflow, we have used retrograde GDA in three patients. All patients did well in the post operative period. One patient developed biliary stricture four months after transplantation and was managed successfully with ERCP and stent placement. We also observed that in patients with extensive dissection extending upto the common hepatic artery (CHA), surprisingly integrity of GDA is preserved.