Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

Abstract

We have preferentially used the right gastroepiploic artery (RGEA) as an alternative for the recipient hepatic artery (HA) inflow during living donor liver transplantation (LDLT), but it was not always available. We herein present a case of adult LDLT with HA reconstruction using a greater saphenous vein (GSV) conduit because of the absence of the RGEA due to prior subtotal gastrectomy. A 55-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis and secondary biliary cirrhosis underwent LDLT using a modified right liver graft. The upper abdominal cavity was heavily adhered due to prior abdominal surgeries, thus we had to sacrifice the common bile duct and the right HA completely. A 6-cm-long GSV segment was harvested from the left ankle and interposed between the recipient gastroduodenal artery and the graft HA. The patient recovered from LDLT and HA complications did not occur. However, 8 years after LDLT, chronic rejection occurred, thus repeated deceased donor liver transplantation was performed. This patient has been doing well for 2 years after retransplantation. In conclusion, we suggest that interposition of an autologous GSV conduit can be an alternative for establishing HA inflow in LDLT when other inflow source is not available.

Clinical applicability of autologous great saphenous vein for living donor liver transplantation

“…The GSV has a small caliber, but its wall is thick and strong, and thus useful for CABG. We also reported a case of a GSV conduit as a hepatic artery replacement when other arterial sources, including the right gastroepiploic artery, were unavailable [15]. Unlike the rarity of a GSV conduit in our experience, a study from Pakistan reported 21 cases of LDLT using a GSV conduit; in these, hepatic artery thrombosis occurred in only one case (4.7%) [18].…”

“…We harvested a 6-cm-long GSV segment from the left ankle and interposed it between the recipient common hepatic artery and the graft hepatic artery (Fig. 10) [15].…”