Aim: Hepatic artery (HA) reconstruction is one of the crucial steps during the process of living donor liver 
transplantation (LDLT). The incidence of hepatic artery thrombosis has been reduced over the last few years 
by the introduction of microsurgical approach under high resolution microscope or loupe. In this study we 
investigate the incidence of hepatic artery thrombosis after introducing the microsurgical approach at our 
Liver Unit. 
Methods: We report our experience in 25 cases of HA reconstruction in LDLT using graft-artery-unclamp 
and posterior-wall-first technique. HA reconstructions were done by specialized microsurgical surgeon.
Results: In our series there was no report of any case with HA thrombosis. The risk factors for failed 
procedures appeared to be reduced by participation of specialized microsurgical surgeon comparing to the 
results in the published data.
Conclusion: HA reconstruction without clamping the graft artery is a feasible and simplified technique. It 
should be done by specialized microsurgical surgeons this could be mastered by transplant surgeons in the 
future with plenty of microsurgical training.