Abstract
To compare early patency and outcomes of single outflow (SOT) and double outflow (DOT) reconstruction in right lobe living donor liver transplantation (RtLDLT) in a multicenter open-labelled randomized controlled trial. Optimum graft venous outflow is a key factor in determining outcomes of RtLDLT. There is no data directly comparing SOT and DOT technique of graft outflow reconstruction. Adult patients undergoing RtLDLT needing anterior sector vein (ASV) reconstruction were enrolled. Prosthetic graft was used to create a neo-middle hepatic vein (neoMHV). Web-based permuted block randomization was used to allocate patients to SOT or DOT (1:1) prior to graft implantation. Primary endpoint was neoMHV patency upto 6 weeks. Secondary endpoints were post-operative morbidity and survival. Intention-to-treat and as-treated analyses are reported. Five centers randomized 219 patients to SOT (n=110) or DOT (n=109). Both groups were similar in baseline characteristics. SOT had better neoMHV patency at 2 weeks (92.5% vs. 82.9%, P=0.032), 4 weeks (84% vs. 69%, P=0.011) but not at 6 weeks (69.5% vs. 59.2%,P=0.124). Cox- proportional hazards analysis revealed DOT (HR- 1.56 (95%ci=1.02,2.4); P=0.041) and use of Dacron graft (HR-2.83(95% ci=1.16,6.94), P=0.023) as independent risk factors for neoMHV thrombosis. SOT was associated with better in-hospital survival (97.3% vs. 90.8%; P=0.044) but similar one-year survival (89% vs. 85%, P=0.340). SOT was associated with improved survival in patients who developed early allograft dysfunction or needed re-operation. SOT has better early neoMHV patency than DOT and may be associated with better early survival.
Published Version
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