DOES THE LIGATION OF GASTRODUODENAL ARTERY PERFORMED AT ARTERIAL STEAL SYNDROME IN LIVING DONOR LIVER TRANSPLANTATION CAUSE COMPLICATIONS IN DUCT-TO-DUCT BILIARY ANASTOMOSIS?

Objective: It was aimed to evaluate whether the ligation of gastroduodenal artery performed for the treatment of arterial steal syndrome diagnosed during hepatic artery reconstruction in living donor liver transplantation (LDLT) cause complications in duct-to-duct bile anastomoses. Material and Method: This retrospective cohort study included patients older than 18 years of age who underwent LDLT and survived for at least 6 months at the Liver Transplantation Unit of General Surgery Department in Medical Hospital of Dokuz Eylul University between June 2000 and July 2017. The patients' demographic data, graft weight, duration of cold ischemia, Child and MELD scores, immunosuppressive agents they used and the presence of postoperative biliary complications after the gastroduodenal artery ligation were investigated. Results: Gastroduodenal artery steal syndrome was diagnosed through Doppler ultrasonography in 11 (4.5%) of 240 patients with LDLT intraoperatively during hepatic artery reconstruction. Of the biliary anastomoses, 8 (72.7%) were indent duct-to-duct anastomosis and 3 (27.3%) were Roux-en-Y Hepaticojejunostomy. The average follow-up time was 3260 (371-4357) days. None of the 8 patients who underwent duct-to-duct biliary anastomosis developed biliary tract complication (p <0.001). Conclusion: Gastroduodenal artery ligation can be performed safely in the treatment of arterial steal syndrome in patients with duct-to-duct biliary anastomosis in LDLT