Liver Transplantation Using Allografts With Hepatic Artery Injury During Procurement: A Propensity Score‐Matched Analysis of Outcomes

Background Hepatic artery (HA) injury during liver procurement is a significant concern in liver transplantation (LT). This study assessed its frequency and impact in deceased donor LT (DDLT). Methods This was a single‐center cohort study of adults who underwent DDLT from 2010 to 2019. HA injury was defined as the section or ligation of arterial branches supplying the graft. Recipients, donors’ characteristics and outcomes of LTs using grafts with HA injury (group 1, n = 35) were compared to LTs using grafts without HA injury (group 2, n = 677). A propensity score matching (PSM) was applied. The primary endpoint was 90‐day hepatic artery thrombosis (HAT); secondary endpoints included major biliary complications, retransplantation, patient, and graft‐survival. Results HA injury occurred in 4.9% of grafts. Aberrant HA anatomy was an independent predictive factor of HA injury (OR = 8.1 [3.7–17.9], p < 0.0001). Arterial reconstruction was required in 53.8% of injured grafts, while 23% had lateral sutures and 23% required no reconstruction. Arterial ischemia time was longer in group 1 (50 min [42–67] vs. 43 min [35–56]; p = 0.007). At 90‐day, HAT (2.9% vs. 0.7%; p = 0.26), major biliary complications (5.7% vs. 7.2%, p>0.99) and retransplantation rates (2.9 % vs. 1%, p = 0.33) were similar. After PSM, theses outcomes remained comparable. The 5‐year patient (74.3% vs. 78.3 %, p = 0.77) and graft‐survival (70.2% vs. 75.6%, p = 0.78) were also similar. Conclusion HA injury during procurement was rare and did not impact mid‐ or long‐term LT outcomes, supporting a “non‐restrictive graft policy” regarding grafts with HA injury.