An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation.
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=17) and an RL group without reconstruction of MHV or its tributaries (group R, n=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<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<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.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Nam-Joon
NJ
Yi
Kyung-Suk
KS
Suh
Hae Won
HW
Lee
Eung-Ho
EH
Cho
Woo Young
WY
Shin
Jai Young
JY
Cho
Kuhn Uk
KU
Lee
D000328:Adult; D015925:Cryopreservation; D004322:Drainage; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000737:chemistry; D011169:Portal Vein / Q000033:anatomy & histology*; D013048:Specimen Handling; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene