title: Usability of ringed polytetrafluoroethylene grafts for middle hepatic vein reconstruction during living donor liver transplantation.
abstract: Large vein allografts are suitable for middle hepatic vein (MHV) reconstruction, but their supply is often limited. Although polytetrafluoroethylene (PTFE) grafts are unlimitedly available, their long-term patency is relatively poor. We intended to enhance the clinical usability of PTFE grafts for MHV reconstruction during living donor liver transplantation (LDLT). Two sequential studies were performed. First, PTFE grafts were implanted as inferior vena cava replacements into dogs. Second, in a 1-year prospective clinical trial of 262 adults undergoing LDLT with a modified right lobe, MHV reconstruction with PTFE grafts was compared with other types of reconstruction, and the outcomes were evaluated. In the animal study, PTFE grafts induced strong inflammatory reactions and luminal thrombus formation, but the endothelial lining was well developed. In the clinical study, the reconstruction techniques were revised to make a composite PTFE graft with an artery patch on the basis of the results of the animal study. MHVs were reconstructed with cryopreserved iliac veins (n = 122), iliac arteries (n = 43), aortas (n = 13), and PTFE (n = 84), and these reconstructions yielded 6-month patency rates of 75.3%, 35.2%, 92.3%, and 76.6%, respectively. The overall 6-month patency rates for the iliac vein and PTFE grafts were similar (P = 0.92), but the 6-month patency rates with vein segment 5 were 51.0% and 34.7%, respectively (P = 0.001). The overall graft and patient survival rates did not differ among these 4 groups. In conclusion, ringed PTFE grafts combined with small vessel patches showed high patency rates comparable to those of iliac vein grafts; thus, they can be used for MHV reconstruction when other sizable vessel allografts are not available.
authors.affiliation: Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jung
authors.forename: Sam-Youl
authors.initials: SY
authors.lastname: Yoon
authors.forename: Jung-Man
authors.initials: JM
authors.lastname: Namgoong
authors.forename: Chun-Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Yo-Han
authors.initials: YH
authors.lastname: Park
authors.forename: Hyeong-Woo
authors.initials: HW
authors.lastname: Park
authors.forename: Hyo-Jun
authors.initials: HJ
authors.lastname: Lee
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D000818:Animals; D001672:Biocompatible Materials / Q000737:chemistry; D003251:Constriction, Pathologic; D015925:Cryopreservation; D004285:Dogs; D058625:End Stage Liver Disease / Q000601:surgery / Q000628:therapy; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery* / Q000637:transplantation; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D019737:Transplants
chemical_list: D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene