Living Donor Liver Transplantation With Vena Cava Replacement

• Published in: Transplantation proceedings Vol. 47; no. 5; pp. 1453 - 1457
• Main Authors: Yagci, M.A, Tardu, A, Karagul, S, Ince, V, Ertugrul, I, Kirmizi, S, Unal, B, Aydin, C, Kayaalp, C, Yilmaz, S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Adolescent; Adult; Blood Vessel Prosthesis; Child; Child, Preschool; End Stage Liver Disease - surgery; Female; Humans; Infant; Liver Transplantation - methods; Living Donors; Male; Middle Aged; Surgery; Treatment Outcome; Vena Cava, Inferior - surgery; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2015.04.019

Abstract Objectives This study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). Materials and Methods We performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. Results Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients ( Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n = 5, IVC n = 4, iliac vein n = 1) or synthetic graft (n = 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). Conclusions Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.