Anterior sector outflow reconstruction using polytetrafluoroethylene (PTFE) graft in right lobe living donor liver transplantation

Abstract

Presenter: Ashish Singhal MBBS, DNB | Fortis Hospitals Background: Outflow reconstruction is very important especially in right lobe (RL) LDLT without MHV. Preserving the MHV with donors add to donor safety but leads to multiple segmental veins in the graft. We aim to describe our surgical technique of anterior sector venous reconstruction using expanded polytetrafluroethylene (ePTFE) graft. Methods: Retrospective analysis of 760 primary RL-LDLTs between December 2011 and June 2018. On bench, we created a “Neo-MHV” using ePTFE graft and anastomosing to segment 5/8 veins in an end-to-end/end-to-side fashion. In past, graft RHV and Neo-MHV were anastomosed to IVC at separate sites. Since February 2016, the end of Neo-MHV was anastomosed with end of graft RHV in side-to-side fashion to create a common ostium and this was anastomosed to caval RHV orifice (single composite drainage). Reconstruction of AS: ePTFE (group A, n = 705) and autologous vein (group B, n = 55). Results: Pre-transplant characteristics were comparable among both groups. Group A has significantly lower CIT (68.7 ±.3.5 minutes vs. 127.8 ± 7.2 minutes; p <.001) and anhepatic time (116.3 ± 5.5 mins vs. 190.81 ± 9.35 mins; p < 0.001). There was no difference in recovery pattern of liver functions, morbidity, and mortality between the two groups. One and 6-months patency rates of interposition grafts were 97.6% and 84.4% (group A) and 96.4% and 78.1% (group B) respectively. Conclusion: In centers with limited access to homologous or autologous vascular grafts, use of ePTFE graft for AS venous outflow reconstruction in RL-LDLT is a viable option with excellent patency and patient outcomes.