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Living Donor Liver Transplantation With Vena Cava Replacement
M A Yagci1, A Tardu1, S Karagul1
1Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
Transplantation Proceedings
|June 22, 2015
Summary
Inferior vena cava (IVC) replacement is rarely needed during living donor liver transplantation (LDLT). Cryopreserved grafts offer successful outcomes for IVC replacement in LDLT patients, primarily for Budd-Chiari syndrome and Echinococcus alveolaris.
Area of Science:
- Hepatobiliary Surgery
- Transplant Surgery
- Vascular Surgery
Background:
- Inferior vena cava (IVC) replacement is an uncommon but necessary procedure in select living donor liver transplantation (LDLT) cases.
- Indications for IVC replacement in LDLT include thrombosis, fibrosis, tumor involvement, and iatrogenic narrowing.
Purpose of the Study:
- To evaluate the indications, surgical techniques, and outcomes of IVC replacement during LDLT.
- To assess the efficacy and patency rates of different graft materials used for IVC replacement.
Main Methods:
- Retrospective analysis of 821 LDLT procedures, identifying 11 cases (1.3%) requiring IVC replacement.
- Analysis of indications for replacement, types of grafts used (cryopreserved or synthetic), and patient outcomes.
Main Results:
- The primary indications for IVC replacement were thrombosis/fibrosis (7 patients, including Budd-Chiari syndrome) and mass involvement (3 patients, including Echinococcus alveolaris).
- Cryopreserved vascular grafts were predominantly used. One patient experienced hepatic outflow obstruction, successfully managed non-operatively. Hospital mortality was 8.9%, unrelated to caval replacement.
- Caval grafts demonstrated successful patency in the remaining patients during a mean follow-up of 7.7 months.
Conclusions:
- IVC replacement, though rare, is a feasible procedure in LDLT.
- Budd-Chiari syndrome and Echinococcus alveolaris are significant indications for IVC replacement.
- Cryopreserved vascular grafts provide successful short-term and long-term patency for IVC replacement in LDLT.
