Application of cryopreserved vein grafts as a conduit between the coronary vein and liver graft to reconstruct portal flow in adult living liver transplantation

Abstract

Adult-to-adult living donor liver transplantation is an alternative to donation from a deceased individual, and can help relieve the shortage of liver donations available for adult patients in Asian countries. When transplant candidates have thrombosis and deterioration of the portal vein, living donor liver transplantation is relatively contraindicated because portal veins in the grafts are short and vein grafts may not be available to reconstruct the portal vein. From June 2003 to May 2007, 82 adult living donor liver transplantations were performed at Chang-Gung Memorial Hospital. Three patients had portal vein thrombosis and marked fibrosis of the portal vein and cryopreserved vein grafts were used to reconstruct portal flow from the engorged coronary vein to the graft portal vein. All vein grafts are patent and all patients have normal liver function at 21-36 months after transplantation. When cryopreserved vein grafts are available, adult living donor liver transplantation can be successfully performed in patients with marked deterioration of the portal vein. The short distance from the engorged coronary vein to the graft portal vein may decrease the incidence of re-thrombosis of the venous conduit.

Novel classification of non-malignant portal vein thrombosis: A guide to surgical decision-making during liver transplantation

“…Table 2 summarises the 37 reported cases (1990-2018) of LGV to portal anastomosis. 9,13,22,34,38,40,45,47,52,[68][69][70][71][72][73][74] All reports were single case reports or small case series (median…”

“…Pan, 2009 38 4 n.a. Wu, 2009 70 3 Patent, well, 21, 36, 36 months after LT Ramos, 2010 40 1 n.a. Kim, 2011 45 3 Shunt patent, long term in 2, thrombosed in 1 patient, all patients well at last follow up Ravaioli, 2011 9 3 n.a., 1 patient died, 2 alive at last follow-up Hibi, 2014 47 1 n.a.…”

Case Report: The Use of Cryopreserved Saphenous Vein in Reconstruction of Transplant Renal Artery Dissection

“…19,20 In the transplant setting, there has been documented use in solid organ transplants, with several studies demonstrating its use in portal vein reconstruction, cryopreserved iliac artery for renal artery and vein reconstruction, and other reports. [21][22][23][24] A more recent study showed the successful use of cryopreserved allografts in renal vessel extension in living donor kidney transplants without late vascular complications. 25 Despite these studies, a major concern is that because cryopreservation preserves living cells, donor endothelium is subject to both cell-and antibody-mediated rejection, [26][27][28][29] which may contribute to a high failure rate.…”

Portal vein reconstruction in adult living donor liver transplantation for patients with portal vein thrombosis in single center experience

“…It is relatively easy to harvest large and long vein grafts from a deceased donor in DDLT, such as common iliac veins and internal jugular veins. Although cryopreserved vein grafts are useful in long arrangements of PV reconstructions, it is difficult to prepare them because they are scarce and expensive, and their patency is controversial . Multivisceral transplantations are possible in patients with diffuse portomesenteric thromboses .…”