Korean J Transplant.  2020 Mar;34(1):31-37. 10.4285/kjt.2020.34.1.31.

Long-term patency and complications of ringed polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation

• Jung IJ
• Hwang S
• Ha TY
• Song GW
• Jung DH
• Ahn CS
• Moon DB
• Kim KH
• Park GC
• Yoon YI
• Park YH
• Cho HD
• Kwon JH
• Chung YK
• Kang SH
• Lee SG

• KMID: 2503780
• DOI: http://doi.org/10.4285/kjt.2020.34.1.31

Abstract

Background
Homologous vein allografts are adequate for reconstruction of the middle hepatic vein (MHV) in living-donor liver transplantation (LDLT). However, supply is a matter of concern. To replace homologous vein allografts, polytetrafluoroethylene (PTFE) grafts were used. This study aimed to assess the long-term patency rates and complications of PTFE grafts used for MHV reconstruction of LDLT in a high-volume liver transplantation center.
Methods
We analyzed the patency rates of PTFE-interposed MHV in 100 LDLT recipients and reviewed complications including PTFE graft migration.
Results
The mean age was 53.5±5.4 years and male to female ratio was 73:27. Primary diagnoses were hepatitis B virus infection (n=71) and other (n=28). Mean model for endstage liver disease score was 16.2±8.3. V5 reconstruction was performed as either single anastomosis (n=85) or double anastomoses (n=14). No V5 reconstruction was required in one patient. V8 reconstruction was performed as single anastomosis, double anastomoses, and no reconstruction in 75, 0, and 25 patients, respectively. During a mean follow-up of 6 years, three recipients required early MHV stenting within 2 weeks. After 3 months, there were no episodes of congestion-associated infarct, regardless of MHV patency. Patency rates of PTFE-interposed MHV were 54.0%, 37.0%, and 37.0% at 1, 3, and 5 years, respectively. Unwanted PTFE graft migration occurred in two recipients, and the actual incidence was 2% at 5 years.
Conclusions
PTFE grafts combined with small-artery patches demonstrated acceptably high short- and long-term patency rates. Since the risk of unwanted migration of PTFE graft is not negligibly low, lifelong surveillance is necessary to detect unexpected rare complications.

Keyword

Polytetrafluoroethylene; Prosthetic graft; Hepatic venous congestion; Patency

Figure

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  Fig. 1 Intraoperative photographs showing the standardized techniques of middle hepatic vein reconstruction using a composite graft of ringed polytetrafluoroethylene (PTFE) and cryopreserved iliac artery patch. (A) The hepatic vein branch orifices at the liver cut surface were widened by a ventral cut, and then an arterial patch was sutured to each orifice. (B) A 10-mm-sized ringed PTFE graft was prepared and end-to-side anastomosis was done between the PTFE graft and arterial patch, making a funnel-shaped intervening arterial patch.

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  Fig. 2 Computed tomography images showing progressive occlusion of the lumen within the interposed polytetrafluoroethylene graft, taken after 3 months (A) and 6 months (B). Despite the deprivation of middle hepatic vein outflow, noticeable hepatic venous congestion was not developed due to intrahepatic venous collateral formation.

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  Fig. 3 A curve of the luminal patency at the polytetrafluoroethylene graft-interposed middle hepatic vein trunk.

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  Fig. 4 Image findings of the polytetrafluoroethylene (PTFE) graft migration. (A) Computed tomography taken 6 months after liver transplantation showed partial penetration of the PTFE graft into the stomach. (B) An endoscopy showed complete penetration of the PTFE graft into the gastric lumen.

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  Fig. 5 Gross photographs of the excised polytetrafluoroethylene graft. (A) Surface discoloration due to exposure to the gastric lumen. (B) Complete occlusion of the internal lumen by thrombus.

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