Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: Microscope vs loupe

James V. Guarrera, Prashant Sinha, Steven J. Lobritto, Robert S. Brown, Milan Kinkhabwala, Jean C. Emond

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Use of operative microscopy (OM) has dramatically reduced the incidence of hepatic artery thrombosis (HAT) in children undergoing segmental liver transplantation. We used OM (12-16x) in our early experience. We changed to high power loupe magnification (6x) after 14 cases. We examined our experience with microvascular hepatic artery reconstruction in 28 consecutive children (< 18 years) who underwent living donor (LDLT) or split liver transplantation (SLT). Reconstructions were done with interrupted, end-to-end anastomoses with 8-0 polypropylene using microvascular techniques. Group 1 consisted of 14 children who underwent LDLT employing OM for the hepatic artery anastomosis. Group 2 consisted of the subsequent 14 children (11 LDLT, 3 SLT) in whom 6x loupe optics were used for the arterial anastomosis. Grafts included 25 left lateral segments, 2 left lobes, and 1 right lobe. Recipients' median age was 1.0 years (range 3 months to 17 years). The mean follow-up time was 27.1 months. There were no cases of HAT. Variables of age, sex, graft type, number of Doppler ultrasound exams (DUS), and biliary complications were similar between groups. Microvascular hepatic artery reconstruction in children with 6x loupe magnification can yield results as good as operative microscopy.

Original languageEnglish (US)
Pages (from-to)585-588
Number of pages4
JournalTransplant International
Issue number10
StatePublished - Oct 2004
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Transplantation


  • Hepatic artery
  • Liver transplantation
  • Microvascular anastomosis
  • Pediatric transplant
  • Segmental graft
  • Technical complication


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