Pediatric living donor liver transplantation: a single center experience from Pakistan

Abstract

Large vein allografts are suitable for MVH reconstruction, but their supply is often limited. PTPF grafts are unlimitedly available with acceptably high mid-term patency rates when being used for MHV reconstruction during LDLT. However, we identified that unwanted PTFE migration into the stomach and other adjacent organs happened in a not negligible proportion as well as a majority of them remained as a foreign body after luminal obliteration with thrombus formation. To replace the use of PTFE graft, we have recently used the cryopreserved aorta homograft more frequently than before. This study intended to present the technical tips and patency outcomes after use of cryopreserved aorta homografts for MHV reconstruction. During the 3-year study period, cryopreserved aorta homograft was used in 30 LDLT recipients. The surgical techniques for MHV reconstruction using cryopreserved aorta homografts and PTFE grafts were very similar because those developed for PTFE grafts was directly applied to cryopreserved aorta grafts. We used arterial patch insertion technique at the liver cut surface because the wall of aorta graft is too thick to perform direct anastomosis. The 6-month patency rate was 92% for aorta and 76% for PTFE graft, showing a significant difference in mid-term patency rates. Overall graft and patient survival rates did not differ according to the MHV interposition vessel materials. In conclusion, cryopreserved aorta grafts combined with small vessel patch showed very high patency rates not comparable to those interposition vessel materials, thus they can be preferentially used for MHV reconstruction when they are available.