Thrombotic Ringed Polytetrafluoroethylene Graft With Infection After Living-Donor Liver Transplantation.

Area of Science:

• Hepatobiliary Surgery
• Transplantation Immunology
• Graft Materials Science

Background:

• Living-donor liver transplantation (LDLT) prioritizes donor safety and graft quality.
• Reconstruction of the middle hepatic vein (MHV) territory in right lobe grafts (R-M) presents outflow challenges.
• Expanded polytetrafluoroethylene (ePTFE) grafts are used for vascular reconstruction, but their complications require further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of ringed expanded polytetrafluoroethylene (rPTFE) grafts in LDLT.
• To compare patient survival rates and graft complications between rPTFE and other reconstruction methods.
• To identify early detection methods for rPTFE-related complications.

Main Methods:

• Retrospective analysis of 129 adult LDLT patients from July 2012 to June 2016.
• Detailed examination of cases involving rPTFE grafts for MHV tributary reconstruction.
• Comparison of patient survival, graft-to-recipient weight ratio (GRWR), and radiological findings.

Main Results:

• The 1-year survival rate for the rPTFE group (73%) was significantly lower than non-rPTFE (89%) and non-reconstructed (97%) groups (P=.008).
• rPTFE grafts were associated with a higher incidence of adjacent organ erosion and gastrointestinal tract penetration.
• Warm ischemic time was significantly longer in the rPTFE group (81 ± 51 minutes) compared to others.

Conclusions:

• rPTFE grafts in LDLT are linked to poorer outcomes and specific complications like GI tract penetration.
• Regular CT scans with contrast are recommended for early detection of rPTFE graft infections and erosion.
• Further research into alternative materials and protective strategies is needed to mitigate ePTFE-related tissue reactions.