PE-234 : A Randomized Control Trial of Left Hepatic Arterial Anastomosis with Graft Right Hepatic Artery Versus Anastomosis with Right Hepatic Artery and Its Impact on Biliary Complications

Aims: It has been pointed out that LHA may not be suitable in all cases. This randomized control trial was conducted to assess whether anastomosis with LHA could be carried out in all the assigned cases and whether the outcome was comparable to anastomosis with RHA of the recipient. Methods: Inclusion criteria:·Living related right lobe adult to adult ABO compatible liver transplantation·Patients planned for duct to duct anastomosis·Single artery in donor graft for anastomosis on preoperative imaging Exclusion criteria:·Retransplantation ·Patients with sclerosing cholangitis or far apart ducts requiring two biliary anastomoses or bilioenteric anastomosis as suggested by preoperative imaging·ABO incompatible·Pediatric liver transplant·Multiple arteries Results: The arterial lumen of the recipient and donor arteries, size mismatch was significantly more in the RHA group. (15% Vs 72%, p-value - 0.03). the early morbidity and mortality was similar in both the groups. Late strictures among survivors were noted more commonly in the RHA group (29.7% vs. 22.7%). Bile leak, mortality, and incidence of late-onset biliary strictures were less common in the LHA group, though the difference was not statistically significant. Conclusions: Anastomosis of the graft artery in a right lobe graft with recipient LHA is feasible in the majority of the cases. The use of LHA was associated with fewer biliary complications in the long term as compared to RHA.