Clinical outcomes of patients with adjacent-organ injuries by expanded polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living donor liver transplantation: a single-center experience

Abstract

Introduction: Congestion of the right liver (RL) anterior section without middle hepatic vein (MHV) may lead to graft dysfunction. Various outflow reconstruction methods have been devised to prevent congestion. An expanded polytetrafluoroethylene (ePTFE) graft may be used for anterior section drainage. We recently experienced several cases of injuries of adjacent organs caused by ePTFE grafts. The aim of this study was to explore these rare complications and their clinical outcomes in a single center. Methods: From January 2005 to December 2016, 638 patients underwent RL living donor liver transplantation draining MVH branches with ePTFE grafts. Medical records of recipients who developed ePTFE-related adjacent-organ injuries were retrospectively reviewed. Results: ePTFE-related adjacent-organ injuries developed in 5 patients (0.78%). The mean interval between transplantation and identification of injury was 73.4±38.1 months. All patients presented with dyspepsia. ePTFE graft induced injury of the gastric antrum or duodenal bulb was observed in 3 patients, one at the small bowel with fistula formation, and another at the common bile duct (CBD). Such injuries were identified by gastroscopy and computed tomography (CT). The patient with gastric antrum perforation did not receive aggressive treatment although the remaining graft penetrated the gastric wall but no leakage. In one patient with duodenal bulb injury, ePTFE graft was removed with gastroscopy. In the remaining 3 patients, surgical exploration and ePTFE graft removal was performed. Conclusion: Although the incidence of adjacent-organ injuries by ePTFE graft is rare, close monitoring of ePTFE grafts is necessary since unexpected injuries can occur during long-term follow-up.