Hemashield Vascular Graft Is a Preferable Prosthetic Graft for Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation

Abstract

BackgroundBecause of the supply shortage for homologous vein allografts, we previously used ringed Gore-Tex vascular grafts for middle hepatic vein (MHV) reconstruction in living donor liver transplantation. However, owing to the subsequent unavailability of ringed Gore-Tex grafts, we replaced them with Hemashield vascular grafts. This study aimed to compare the patency of Hemashield grafts with that of ringed Gore-Tex grafts.Material/MethodsThis was a retrospective double-arm study between the study group that used Hemashield grafts (n=63) and the historical control group that used ringed Gore-Tex grafts (n=126).ResultsIn the Gore-Tex and Hemashield groups, mean age was 53.1±6.2 and 54.3±10.4 years; model for end-stage liver disease score was 16.5±8.3 and 17.5±9.9; and graft-recipient weight ratio was 1.11±0.23 and 1.12±0.25, respectively. In the Gore-Tex graft group, V5 reconstruction was done in single (n=107, 84.9%), double (n=17, 13.5%), and none (n=2, 1.6%). V8 reconstruction was done in single (n=95, 75.4%), double (n=1, 0.8%), and none (n=30, 23.8%). In the Hemashield group, V5 reconstruction was done in single (n=43, 68.3%), double (n=19, 30.2%), and triple (n=1, 1.6%). V8 reconstruction was done in single (n=45, 71.4%), double (n=9, 14.3%), and none (n=9, 14.3%). One-year conduit patency rates in the Gore-Tex and Hemashield groups were 54.8% and 71.6%, respectively (p=0.048).ConclusionsMHV reconstruction using Hemashield vascular grafts demonstrated higher short-term patency rates than those associated with ringed Gore-Tex vascular grafts. We suggest that the Hemashield vascular graft is one of the best prosthetic materials for MHV reconstruction.

Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation

“…MHV reconstruction for LDLT using a modified right liver graft has resulted in new demands for vascular homografts, and the increase in LDLT numbers had led to a relative shortage in their supply. Every available vessel material has been used for MHV reconstruction in many institutions, including various vascular homografts, prosthetic vascular grafts and autologous veins [ 2 3 4 5 6 7 ].…”

“…In accordance with our institutional LDLT management protocols, posttransplant dynamic CT scans were taken weekly when the patients were in the hospital and at 1, 3, 6, and 12 months after the liver transplantation operation. Thereafter, a follow-up abdomen-pelvis CT was conducted annually for 5 years and biannually after 5 years [ 7 ].…”

“…Middle hepatic vein (MHV) reconstruction with vessel graft interposition is one of the standard procedures for living donor liver transplantation (LDLT) using a modified right lobe graft. Various interposition conduit materials have been used for this procedure, including homologous and autologous vessels and prosthetic vascular grafts [ 1 2 3 4 5 6 7 ]. Since the supply of vascular homografts is very limited in Korea, we have used prosthetic vascular grafts including ringed polytetrafluoroethylene and collagen-impregnated woven double velour polyester grafts (Hemashield Platinum, Maquet, Rastatt, Germany) in combination with small-artery patches [ 6 7 ].…”

“…Various interposition conduit materials have been used for this procedure, including homologous and autologous vessels and prosthetic vascular grafts [ 1 2 3 4 5 6 7 ]. Since the supply of vascular homografts is very limited in Korea, we have used prosthetic vascular grafts including ringed polytetrafluoroethylene and collagen-impregnated woven double velour polyester grafts (Hemashield Platinum, Maquet, Rastatt, Germany) in combination with small-artery patches [ 6 7 ]. The short- and long-term patency rates of these prosthetic graft conduits have proved to be comparable to those of cryopreserved iliac vein and aorta homografts [ 5 6 7 ].…”

“…Since the supply of vascular homografts is very limited in Korea, we have used prosthetic vascular grafts including ringed polytetrafluoroethylene and collagen-impregnated woven double velour polyester grafts (Hemashield Platinum, Maquet, Rastatt, Germany) in combination with small-artery patches [ 6 7 ]. The short- and long-term patency rates of these prosthetic graft conduits have proved to be comparable to those of cryopreserved iliac vein and aorta homografts [ 5 6 7 ]. Notably however, some prosthetic graft-associated complications such as accidental gastric penetration by the graft have sporadically occurred [ 8 9 10 11 ].…”