title: Living Donor Liver Transplantation With Vena Cava Replacement.
abstract: OBJECTIVE
  This study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT).
  
  
  METHODS
  We performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes.
  
  
  RESULTS
  Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n = 5, IVC n = 4, iliac vein n = 1) or synthetic graft (n = 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months).
  
  
  CONCLUSIONS
  Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey. Electronic address: maliyagci@gmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Yagci
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Tardu
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Karagul
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: V
authors.initials: V
authors.lastname: Ince
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Ertugrul
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kirmizi
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Unal
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Aydin
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*; D055815:Young Adult