"V-Plasty" technique using dual synthetic vascular grafts to reconstruct outflow channel in living donor liver transplantation.
BACKGROUND
The reconstruction of outflow is a crucial step in living donor liver transplantation. This study describes a suitable technique that uses synthetic vascular conduits in presence of multiple draining veins of right lobe of liver and the outcome of the recipients to evaluate safety of using multiple synthetic grafts.


METHODS
From March 2011 to September 2014, 325 patients underwent right lobe living donor liver transplantation. Expanded polytetra-fluoroethylene (ePTFE) grafts were used in total 155 of the liver allografts. Among these, 16 liver grafts required dual ePTFE grafts to reconstruct the outflow due to presence of multiple hepatic veins.


RESULTS
The mean diameters for venous branches of segment 5 (V5) and 8 (V8) were 5 mm (range, 4-8 mm) and 7 mm (range, 5-9 mm). The mean diameter of inferior right hepatic veins was 8 mm (7-10 mm). All the recipients who received the right liver with dual ePTFE grafts showed satisfactory inflow and outflow immediately after reconstruction as measured by Doppler flowmetry. Postoperative ultrasonographic studies showed no disturbances in outflow. Protocol dynamic computed tomography performed in the second postoperative month showed 100% patency rates of the artificial grafts. At median follow-up of 24 months graft survival was achieved in 88%, whereas the patency rates of the ePTFE grafts were 100%.


CONCLUSIONS
The use of "V-Plasty" technique using dual artificial vascular grafts is a safe and feasible technique in the presence of various allograft venous anomalies & ensures a single venous channel for outflow reconstruction. Our study also suggests that ePTFE graft may be a useful interposition material without serious complications.
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan. Electronic address: otc@mail.cmuh.org.tw.
Long-Bin
LB
Jeng
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Ashok
A
Thorat
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan.
Ping-Chun
PC
Li
College of Medicine, China Medical University, Taichung, Taiwan; Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan.
Ming-Li
ML
Li
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Horng-Ren
HR
Yang
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Chun-Chieh
CC
Yeh
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
Te-Hung
TH
Chen
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
Chia-Hao
CH
Hsu
Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
Shih-Chao
SC
Hsu
College of Medicine, China Medical University, Taichung, Taiwan; Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan.
Kin-Shing
KS
Poon
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene