The effects of gabexate mesilate on the microsurgical reconstruction of the hepatic artery in living donor liver transplantation

Objectives Microsurgical reconstruction of hepatic artery is essential but require challenging techniques especially for living donor liver transplantation (LDLT), because the recipient artery is short, located deep, and usable vessel grafts are limited. Furthermore, hepatic artery thrombosis (HAT) can be a lethal complication. Therefore, we began the systemic administration of gabexate mesilate, a strong serine protease inhibitor. It has often been effective to treat disseminated intravascular coagulation. The purpose of this study was to examine the effects of gabexate mesilate on the microvascular reconstruction. Methods From 1991 to 2009, we performed 134 microsurgical reconstructions of LDLT. This retrospective investigation of those cases divided them into four groups: group I, anticoagulation with heparin (n = 3); group II, heparin and gabexate mesilate (20 mg/kg/d; n = 26); group III, heparin and full-dose gabexate mesilate (40 mg/kg/d; n = 72); and group IV, full-dose gabexate mesilate alone (n = 33). Groups I and II were mainly pediatric cases (left lobe grafts only); groups III and IV, adult cases (left: right = 57:48). Using ultrasonography to 14 days, we investigated HAT by examining pulsatile index, resistive index, and acceleration time. Results HAT occurred in groups I, II, III, and IV at 33.3% (1/3), 11.5% (3/26), 6.9% (5/72), and 0% (0/33), respectively. The 5-year survival rates of groups III + IV versus groups I + II were 82.4% and 71.1%, respectively (P < .05). In HAT cases, even before the event the acceleration times were delayed to over 100 milliseconds. Conclusion Gabexate mesilate administration was safe for and protective of microvascular reconstructions in LDLT.