An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation

Abstract

Congestion in the anterior section in a right liver (RL) without a middle hepatic vein (MHV) may lead to graft dysfunction. To solve this problem, an RL draining MHV branches with autologous or cryopreserved vessels can be introduced. However, these vessels are often unavailable, and their preparation is time-consuming. An expanded polytetrafluoroethylene (ePTFE) graft may be used for anterior section drainage. Between February and November 2005, 26 recipients underwent RL liver transplantation draining MHV branches with an ePTFE graft (group P). Twenty-six ePTFE grafts (6 or 7 mm in internal diameter) drained 35 MHV branches on the back table to the graft right hepatic vein or to the recipient's inferior vena cava. The patency of the ePTFE graft was checked with computed tomography scans of the liver. The outcome of group P was compared with those of an RL group with MHV (group M, n ϭ 17) and an RL group without reconstruction of MHV or its tributaries (group R, n ϭ 85). The 1-month and 4-month patency rates (PRs) of the ePTFE grafts were 80.8% (21/26) and 38.5% (10/26). All showing early obstruction of the ePTFE graft had congestion in the anterior section, but all showing late obstruction were asymptomatic. The 1-month PRs of group P were comparable to, but the 4-month PRs were lower than, those of group M (both 94.1%; P Ͻ 0.05). However, 1-year patient and graft survival rates of group P (both 100%) were comparable to those of group M (94.1% and 100%) and better than those of group R (83.5% and 88.2%; P Ͻ 0.05). In conclusion, the early PR of group P was good, and late obstruction of the ePTFE graft had no impact on congestion in the anterior section or patient survival. Therefore, an ePTFE graft may be a useful interposition material for anterior section drainage in RL transplantation without serious complications.

Technical Refinement of Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Left Liver Graft

“…However, a few studies have demonstrated the importance of the outflow reconstruction from the point of view of avoiding SFSS. In LDLT cases using right liver graft, the reconstruction of MHV tributaries or right inferior hepatic vein have been well documented to avoid graft congestion [10,11]. As mentioned before, the outcome of LDLT recipients using a left liver graft is reported to be not different from that using a right liver graft in spite of the fact that left liver volume is generally smaller than right liver volume, possibly because the whole left liver is well drained via the middle and left hepatic veins.…”

Synthetic Graft for Reconstruction of Middle Hepatic Vein Tributaries in Living-Donor Liver Transplant

“…In another study, although the 4-month patency rate was less than 50% none had complications related to graft congestion. 16 Patency of cryopreserved vessels is thought to be higher than ePTFE grafts because a large percentage of luminal endothelial cells that remain viable at implantation are invaded with fibroblasts, making them less thrombogenic. 17 In a recent study, a composite graft using a synthetic graft and an artery patch to improve patency time was tried.…”

Living-Donor Liver Transplant Using the Right Hepatic Lobe Without the Right Hepatic Vein: Solving the Drainage Problem

“…Yi and associates 15 have reported successful use of the polytetrafluoroethylene to include V5 and V8 in the drainage. The saphenous vein used in our case was obtained from another patient's varicotomy operation while the aortic graft was obtained from deceased cases.…”