Outcomes of living donor liver transplantation using graft with multiple hepatic arteries on the graft: Propensity score-matched analysis

Background: This study aims to analyze the outcomes of living donor liver transplantation (LDLT) using grafts with multiple hepatic arteries (HAs), compared to those with a single HA.Methods: A retrospective analysis was conducted on 1,059 LDLT patients from July 2005 to December 2022 at Severance Hospital, South Korea.Patients were categorized into multiple-HA and single-HA groups.Propensity score matching was employed to balance baseline characteristics, with primary outcomes being graft survival and secondary outcomes including HA, biliary, and total vascular complications. Results:The study included 27 patients in the multiple-HA group and 925 in the single-HA group before matching.After propensity score matching, no significant difference in 5-year graft survival rates was observed between the groups (60.4% for multiple-HA vs. 72.8%for single-HA, p=0.172).However, the multiple-HA group exhibited a higher incidence of bile duct complications (80.0% vs. 48.3%,p=0.038).Multivariable Cox regression analysis did not find multiple HAs to be a significant predictor of graft loss but confirmed their association with increased bile duct complications.Conclusion: LDLT using grafts with multiple HAs does not adversely affect overall graft survival compared to single-HA grafts.Nevertheless, the increased risk of bile duct complications associated with multiple HAs necessitates careful surgical planning and postoperative management to mitigate this risk.