Material Impact On the Patency of Reconstructed Middle Hepatic Vein in the Living Donor Liver Transplantation Using the Right Liver.

Abstract

Background Recovery of postoperative liver function is affected by the patency of middle hepatic vein (MHV) after reconstruction in living donor liver transplantation. The aim of the study was to evaluate the patency rate of reconstructed MHV according to the reconstruction material in living donor liver transplantation using the right liver. Methods From Aug, 2003 to Dec. 2012 at the Seoul St. Mary's Hospital in Seoul, Republic of Korea, 521 patients received a right liver graft. Patients were divided into six groups by MHV reconstruction material: No MHV reconstruction (n = 98); MHV was reconstructed by Greater Saphenous Vein (n =21); reconstructed by recipient's Portal Vein (n = 220); reconstructed by PTFE graft (n=97); reconstructed by Goretex graft (n = 9); reconstructed by Dacron graft (n = 74). The patency periods was compared among groups. Maintenance of patency of MHV was evaluated by computed tomography angiography at 7 days, 20 days, 90 days and 1 year postoperatively. Results In recipient's greater saphenous vein group, 7 days, 20 days, 90 days and 1 year underwent CT confirmed the closure rate of MHV blood flow were 33.3%, 4.8%, 19.0% and 9.5%, at 1 year underwent CT, the rate that blood flow is well maintained was 28.6%. During the study period, follow up loss cases because of the death were 4.8%. In recipient's portal vein group, each closure rate of MHV blood flow were 37.7%, 4.5%, 7.3%, 3.6%. The rate that blood flow is well maintained was 44.5%. And the death rate was 2.3%. In Goretex group, each closure rate of MHV blood flow were 22.2%, 11.1%, 11.1%, 22.2%. The rate that blood flow is well maintained was 22.2%. And the death rate was 11.1%. In PTFE group, each closure rate of MHV blood flow were 24.7%, 6.2%, 21.6%, 17.5%. The rate that blood flow is well maintained was 26.8%. And the death rate was 3.1%. And last in Dacron group, each closure rate of MHV blood flow were 31.1%, 12.2%, 16.2%, 8.1%. The rate that blood flow is well maintained was 24.3%. And the death rate was 8.1%. Conclusion In PTFE group, the initial maintenance of MHV blood flow using PTFE group was found to be well maintained. In intrahepatic portal vein of recipient group, the long term maintenance of MHV blood flow over 1 year was found to be well maintained.