Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):46-53. 10.14701/ahbps.2021.25.1.46.

Patency of Hemashield grafts versus ringed Gore-Tex grafts in middle hepatic vein reconstruction for living donor liver transplantation

• Kim SH
• Hwang S
• Kim M
• Ha TY
• Song GW
• Jung DH
• Ahn CS
• Moon DB
• Kim KH
• Park GC
• Lee SG

• KMID: 2513175
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.46

Abstract

Backgrounds/Aims
Owing to the short supply of homologous vein allografts, we previously used ringed Gore-Tex vascular grafts for middle hepatic vein (MHV) reconstruction in living donor liver transplantation. When ringed Gore-Tex grafts became unavailable, we used Hemashield vascular grafts. This study aimed to compare the patency and complication rates of Hemashield and ringed Gore-Tex grafts.
Methods
This retrospective two-arm study compared the study group that received Hemashield grafts (n=157) and the propensity score-matched control group that received ringed Gore-Tex grafts (n=157).
Results
In the Hemashield and Gore-Tex groups, the recipient age was 54.7±9.4 and 53.3±6.3 years; Model for End-stage Liver Disease scores were 15.9±9.2 and 16.9±8.3; and graft-recipient weight ratios were 1.07±0.24 and 1.10±0.23, respectively. In the Hemashield group, V5 reconstruction was performed using single (n=113, 72.0%), double (n=39, 24.8%), and triple (n=3, 1.9%) anastomoses. The proportion of double and triple anastomoses for V5 and V8 was higher in the Hemashield group than in the Gore-Tex group. Two (1.3%) patients required MHV conduit stenting owing to early thrombosis of the Hemashield graft. There was no difference in conduit occlusion-free patient survival rates between groups (p=0.91). The incidence of accidental conduit migration in the Hemashield and Gore-Tex groups was 0 (0%) and 2 (1.3%), respectively.
Conclusions
Hemashield grafts used in MHV reconstruction demonstrated acceptably high short- and mid-term patency rates, no incidences of conduit migration, easy handling, and good flexibility for length adjustment. Therefore, we suggest that the Hemashield graft is the preferentially suitable prosthetic material for MHV reconstruction.

Keyword

Prosthetic graft; Hepatic venous congestion; Patency; Thrombosis; Graft migration

Figure

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  Fig. 1 Intraoperative photographs showing techniques for middle hepatic vein reconstruction using a Hemashield vascular graft. (A) Vascular patches are attached at the V5 and V8 openings, and a 12-mm Hemashield graft is anastomosed on the back table. The conduit is anastomosed to the recipient’s inferior vena cava (IVC) in a side-to-end fashion. (B) A 10-mm Hemashield graft is attached to the liver graft using a single or double V5 anastomosis and a single V8 anastomosis, and this is anastomosed to the recipient’s IVC in an end-to-end fashion. (C) A 12-mm Hemashield graft is attached to the liver graft with a single V5 anastomosis and a single V8 anastomosis, and this is conjoined with the liver graft’s right hepatic vein orifice. A saphenous vein patch is attached around the conjoined orifice. The conjoined right and middle hepatic vein orifice is anastomosed to the recipient’s IVC.

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  Fig. 2 Schematic illustration of reconstruction techniques for anastomosis of a Hemashield graft conduit to the recipient’s left-middle hepatic vein trunk stump. There are three types of anastomosis: (A) end-to-end anastomosis, (B) side-to-end anastomosis, and (C) oblique cutting of the conduit end and patch venoplasty. The colored area represents a vein patch.

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  Fig. 3 Serial computed tomography (CT) images showing progressive occlusion of the lumen within the interposed Hemashield graft. Liver CT scans were performed at: (A) 4 days, (B) 1 month, (C) 3 months, and (D) 24 months after transplantation. Middle hepatic vein outflow was nearly completely occluded around 3 months, but no hepatic venous congestion occurs, due to the development of intrahepatic venous collaterals. The thrombosed Hemashield graft conduit is visible (D). Yellow arrows indicate luminal blood flow within the interposed Hemashield graft. Red arrows indicate the thrombus-filled Hemashield graft conduit.

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  Fig. 4 Comparison of occlusion-free patient survival curves for different prosthetic vascular graft materials.

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