Ann Liver Transplant.  2022 May;2(1):102-106. 10.52604/alt.22.0013.

A critical complication of the interposition grafts using a cryopreserved aortic allograft for middle hepatic vein reconstruction in living donor liver transplantation

• Han SJ
• Kim SH
• Chon GS
• Song IS

• KMID: 2560888
• DOI: http://doi.org/10.52604/alt.22.0013

Abstract

Cryopreserved iliac vein allografts are suitable for middle hepatic vein reconstruction during living-donor liver transplantation, but their supply is often limited. Cryopreserved aorta allografts (CAG) are now one of the reliable resources, and those patency rates are comparable with polytetrafluoroethylene (PTFE) grafts. However, PTFE grafts have drawbacks of accidental gastric penetration and non-degradable foreign body. A similar complication can occur because the CAG has a similar property to PTFE, like elastic force against the pressure around organs. In this case, the patient was admitted to the ICU in hypovolemic shock due to internal bleeding. The fistula formation of the duodenum with the CAG was the reason. The patient recovered without complications after the operation, gastrojejunostomy, and feeding jejunostomy, but we did not excise the CAG. After fistulectomy, both CAG and the duodenum openings were closed with 5-0 prolene. Our experience with this case suggests that the CAG can cause problems to the adjacent organ because of its hard nature.

Keyword

Aorta; Allografts; Living donors; Liver transplantation; Fistula

Figure

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  Figure 1 (A) Preventive endoscopic variceal ligation (#6). (B) Computed tomography taken 4 days after living donor liver transplantation using a modified right liver graft shows the usual posttransplant findings. (C) Direct topography taken shows normal anatomy of bile duct tree. (D) The explant liver shows advanced liver cirrhosis with tumors.

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  Figure 2 (A) Duodenal ulcer bleeding with clots formation. (B) A large amount of hematoma along the duodenal wall, 1st and 2nd portion of the duodenum.

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  Figure 3 (A) Middle hepatic vein reconstructed with cryopreserved aorta graft, sutured. (B) Duodenal ulcer perforation site.

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  Figure 4 (A) Computed tomography (CT) taken at postoperative 20 days showed the normal contour of the duodenum. (B) CT taken one year after living-donor liver transplantation shows the usual findings following transplantation using a modified right graft. (C) Gastroduodenoscopy taken one year after the event shows normal appearance of mucosal integrity without ulceration.

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  Figure 5 Calcification was seen in the wall of cryopreserved aortic graft (A, arrows) and there was adhesion of reconstructed middle hepatic vein with duodenum (B, arrows).

Reference

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