Ann Liver Transplant.  2022 Nov;2(2):157-161. 10.52604/alt.22.0026.

Asymptomatic migration of hemashield vascular graft used for middle hepatic vein reconstruction of living donor liver transplantation

• Oh RK
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Kang WH
• Yoon YI
• Lee H
• Hwang S

• KMID: 2560912
• DOI: http://doi.org/10.52604/alt.22.0026

Abstract

Middle hepatic vein (MHV) reconstruction with interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT). Unwanted migration of a synthetic vascular graft into the hollow viscus has been sporadically reported. We herein present a case of Hemashield graft migration into the duodenum following LDLT. A 64-year-old male patient presented with LDLT due to liver cirrhosis and hepatocellular carcinoma. The MHV openings in the right liver graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient middle-left hepatic vein trunk. The patient had uneventful recovery after LDLT surgery. Computed tomography (CT) scans taken at one year and two years showed no abnormal finding. However, gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb. The patient had no signs or symptoms and no problems with diet. The Hemashield graft migration was identified by retrospective review of 1-year and 2-year CT scans probably due to no radio-opacity of Hemashield graft. Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more. The patient has been doing well for two years six months after LDLT. In conclusion, every synthetic vascular graft can penetrate adjacent organs and soft tissues, and its incidence is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using synthetic vascular grafts.

Keyword

Hepatic venous congestion; Liver transplantation; Hemashield graft; Middle hepatic vein; Hollow viscus