Background : Surgical techniques and perioperative management proficiency have led to improvements in liver transplant (LT) outcomes. However, vascular complications after LT continue to be experienced that requiring urgent intervention. We analyzed the arterial complications and treatment in a single center.

Methods : Between 1997 and 2023, we performed 336 living donor LT (LDLT). All arterial reconstructions were performed under a microscope using end-end interrupted suture techniques. For the first two weeks, liver blood flow was confirmed twice daily using Doppler ultrasound.

Results : Arterial complications developed in 20 cases (5.5%).　There were 14 cases of thrombosis, 3 cases of dissection, and 3 cases of bleeding from anastomosis. Reanastomosis was performed in 13 out of 20 cases. Reopening was achieved in 10 cases, but in 3 cases, occlusion occurred shortly thereafter, resulting in graft failure and death. Additionally, in two other cases among the 20, attempted reanastomosis during surgery did not achieve reopening, leading to poral vein arterialization. One case was lost due to infection, but another case achieved long-term survival. The patient survival rate of the arterial complications group was significantly worse at 1 year (59%), 3 years (53%), and 5 years (48%) compared to the group without arterial complications, which had rates of 84%, 78%, and 71%, respectively (p<0.01).

Conclusions : Even when reopening was achieved, the group with arterial complications had a poor prognosis. It is desirable to have meticulous surgery during the initial operation, early detection using Doppler ultrasound, and management that considers early retransplantation.