Ann Liver Transplant.  2022 Nov;2(2):127-131. 10.52604/alt.22.0025.

Migration of synthetic vascular graft used for middle hepatic vein reconstruction during living donor liver transplantation using a modified right liver graft: A collective review of worldwide cases

• Chung YK
• Park CS

• KMID: 2560907
• DOI: http://doi.org/10.52604/alt.22.0025

Abstract

Middle hepatic vein (MHV) reconstruction with an interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT) using a right lobe graft when the donor's MHV trunk is preserved in the donor's remnant liver. Although large-size vein allografts are suitable for MHV reconstruction, their supply is often limited. Various synthetic vascular grafts (SVGs) have been frequently used due to their availability and high patency rates. However, unwanted migration of an SVG into the hollow viscus is an unexpected serious complication. Since its first report in 2011, at least nine case reports or short series of SVG migration following LDLT have been published. Postoperative complications and interventional treatments undertaken are other influencing factors of SVG-associated complications. Contrast-enhanced computed tomography is the best modality for early detection of SVG-related complications including infection and suspected gastrointestinal tract penetration. The second study is endoscopic evaluation of the stomach, duodenum, and other adjacent structures. There is no definite consensus about the treatment of SVG migration into a hollow viscus. The majority of patients undergo definitive treatment including surgical removal. However, some patients without any symptoms or sign are under close observation. In conclusion, the risk of unwanted SVG migration is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using SVG.

Keyword

Hepatic venous congestion; Liver transplantation; Polytetrafluoroethylene; Middle hepatic vein; Hollow viscus