Ann Liver Transplant.  2021 Nov;1(2):153-159. 10.52604/alt.21.0025.

Technical refinement of inferior vena cava replacement using a synthetic vascular graft in living donor liver transplantation

• Moon DB
• Hwang S
• Ahn CS
• Ha TY
• Song GW
• Jung DH
• Park GC
• Yoon YI
• Lee SG

• KMID: 2560866
• DOI: http://doi.org/10.52604/alt.21.0025

Abstract

The native inferior vena cava (IVC) can be resected during living donor liver transplantation (LDLT) in Budd-Chiari syndrome or advanced hepatocellular carcinoma (HCC). The present study aimed to present the technical details of IVC replacement with synthetic vascular graft interposition. Following laparotomy, the recipient liver was mobilized to expose the IVC. Piggyback or classical total hepatectomy including IVC was performed. In patients with Budd-Chiari syndrome, atrio-caval anastomosis with a vascular graft is necessary, in which clamp slippage should be completely prevented. No-touch en bloc isolation of the native liver is necessary for patients with advanced HCC. The wall of a large-caliber vascular graft is pleated to prevent luminal collapse, suggesting the need for tension to stretch it. The length of a vascular graft should be adjusted meticulously. An adequately interposed vascular graft appears to be rather short under IVC cross-clamping, but elongated and expanded after restoration of the IVC flow. A single right or left liver graft, or even dual-graft can be implanted to the interposed IVC vascular graft. An elliptical excision of the graft wall is mandatory for graft hepatic vein implantation, because an incision at the graft does not expand. In conclusion, IVC replacement with interposition of a synthetic vascular graft expands the indications for LDLT, particularly in patients with Budd-Chiari syndrome and advanced HCC, similar to those of deceased donor liver transplantation.

Keyword

Living donor liver transplantation; Budd-Chiari syndrome; Graft outflow vein obstruction; Hepatocellular carcinoma; Synthetic graft