title: Usability of Cryopreserved Aortic Allografts for Middle Hepatic Vein Reconstruction During Living-Donor Liver Transplantation.
abstract: Iliac vein allografts are suitable for middle hepatic vein (MHV) reconstruction during living-donor liver transplantation (LDLT), but their supply is often limited. Polytetrafluoroethylene (PTFE) grafts are easily available but have drawbacks of accidental gastric penetration and non-degradable foreign body. To replace the use of PTFE grafts, we started using cryopreserved aorta allografts (CAAs). This study presents the technical details and patency outcomes of using CAAs in MHV reconstruction. We reviewed the surgical techniques of CAA interposition and analyzed the patency rates in 74 patients who underwent LDLT during the 6-year study period. The two control groups received either cryopreserved iliac veins (n = 122) or PTFE grafts (n = 84). The surgical techniques for MHV reconstruction used to implant the CAA and PTFE grafts are very similar because the techniques developed for PTFE grafts were also applied to CAAs. We inserted an arterial patch at the liver cut surface because the CAA wall is too thick to perform direct anastomosis. Two patients (2.7 %) underwent MHV stenting during the first month. The 1-year patency rate was 69.7 % in the CAA group vs. 39.2 % in iliac vein group vs. 57.2 % in PTFE group (p = 0.000). The overall graft and patient survival rates did not differ depending on the MHV interposition vessel materials (p > 0.1). CAAs combined with small-artery patches demonstrated high patency rates that surpass other vessel grafts, and thus, we suggest that CAA can be reliably used for MHV reconstruction when CAA is available.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Seok-Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. shwang@amc.seoul.kr.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D064591:Allografts; D001011:Aorta / Q000637:transplantation*; D015925:Cryopreservation; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000706:statistics & numerical data*
keywords: Hepatic venous congestion; Iliac vein graft; Patency; Polytetrafluoroethylene; Prosthetic graft