Impact of Hepatic Artery Diameter on Immediate Postoperative Graft Function and Hemodynamic Profiles in Living-Donor Liver Transplantation: A Retrospective Cohort Study

Background and Objectives: Reconstruction of small-caliber hepatic arteries (HAs) in living-donor liver transplantation (LDLT) is technically challenging. We evaluated clinical and hemodynamic outcomes according to intraoperative HA diameter in a retrospective single-center cohort of 49 patients who underwent LDLT between 2017 and 2026. Materials and Methods: Patients were stratified into Group 1 (≤2.0 mm, n = 28), Group 2 (2.5 mm, n = 6), and Group 3 (≥3.0 mm, n = 15). Perioperative variables, laboratory markers of graft function for 14 days, and Doppler hemodynamic parameters for 7 days were analyzed using linear mixed models; HA diameter was also analyzed as a continuous variable, with adjustment for graft-to-recipient weight ratio and MELD-Na score. Results: Baseline and surgical variables did not differ significantly, and neither group nor group × time effects were significant for any outcome. Per 1-mm increase in diameter, AST and ALT ratios were 1.01 (95% CI 0.83–1.23) and 1.06 (0.79–1.42). Early allograft dysfunction occurred in 5 patients (indeterminate in 3). No hepatic artery thrombosis, arterial re-intervention, retransplantation or 90-day death was documented; 14 patients (28.6%) required biliary intervention. Conclusions: In this small cohort, a smaller donor HA diameter was not associated with worse early biochemical or Doppler trajectories, but the estimates were imprecise and cannot establish equivalence or vascular safety.