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Usability of cryopreserved aorta homografts for middle hepatic vein reconstruction during living donor liver transplantation
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Electronic Poster Abstracts
EP05B-030 USABILITY OF CRYOPRESERVED AORTA HOMOGRAFTS FOR MIDDLE HEPATIC VEIN RECONSTRUCTION DURING LIVING DONOR LIVER TRANSPLANTATION S. -H. Kim, C. -S. Ahn, T. -Y. Ha, S. Hwang, D. -H. Jung, K. -H. Kim, S. -G. Lee, D. -B. Moon, G. -C. Park, G. -W. Song and W. -H. Kang Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine/Asan Medical Center, Republic of Korea 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.
EP05B-031 PORTAL VEIN STENTING IS A SIGNIFICANT RISK FACTOR FOR BILIARY STRICTURE IN ADULT LIVING DONOR LIVER TRANSPLANTATION: MATCHED CASECONTROL STUDY M. H. Shin, D. B. Moon, S. G. Lee, S. Hwang, K. H. Kim, C. S. Ahn, T. Y. Ha, G. W. Song, D. H. Jung, G. C. Park and Y. I. Yun Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Although perioperative portal vein (PV) stenting has been successfully performed to treat steno-occlusive
disease in adults undergoing living donor liver transplantation (LDLT), the incidence of biliary anastomotic stricture (BAS) after PV stenting was high. This matched case-control study was designed to clarify the relation between BAS and PV stenting, and to determine the mechanism of BAS and measures to reduce its incidence. Fortyfour LDLT recipients who underwent stenting crossing the PV anastomosis were classified as the Stent group and matched 1:3 with a Control, non-stented group (n = 131). The incidence of BAS was significantly higher in the Stent than in the Control group (43.2% versus 17.6%, p = 0.001). Cumulative 6 month and 1, 2, and 5 year BAS rates were 31.8%, 34.1%, 41.4%, and 43.2%, respectively, in the Stent group and 13.0%, 13.8%, 16.1%, and 17.8%, respectively, in the Control group (p = 0.001). Multivariate analysis showed that the size of the bile-duct (BD) opening, PV stenting, and acute cellular rejection were independent risk factors for BAS. A PV stent crossing the anastomosis may place extrinsic pressure on the adjacent peribiliary vascular plexus of the graft side, resulting in pressure-induced ischemic damage to the BD and BAS. In conclusion, PV stenting per se is an independent risk factor for BAS. Although PV stenting is a reliable and convenient modality in the treatment of steno-occlusive PV during adult LDLT, stent placement crossing the PV anastomosis should be avoided, even when indicated.
EP05B-032 PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION: A SINGLE CENTER EXPERIENCE FROM PAKISTAN F. S. Dar1, A. B. H. Bhatti1, S. Hashmi2, H. Zia1, M. I. Malik2, E. A. Khan3 and N. H. Shah4 1 HPB and Liver Transplantation, 2Pediatric Hepatology, 3 Pediatrics, and 4Transplant Hepatology, Shifa International Hospital, Pakistan Introduction: Outcome of pediatric living donor liver transplantation (LDLT) depends on multiple factors. In developing countries, lack of public awareness, restricted ancillary support services, limitations in technical expertise and a brittle healthcare system makes pediatric LDLT a daunting task. The objective of the current study was to report for the first time outcomes of pediatric LDLT recipients from Pakistan. Methods: All patients in pediatric age group (17 years) who underwent LDLT between April 2012 and April 2015 were included to ensure a minimum follow up of 3 months. In this period 14 pediatric LDLT’s were performed. We assessed all Grade 2 and above complications on ClavieneDindo grading system and included them as morbidity. For the purpose of this study, we assessed 90 day morbidity and mortality. Results: Median age was 8.5 years and ranged between 6 months and 17 years. Wilson disease (28.6%) and cryptogenic cirrhosis (28.6%) were the two most common aetiologies. Acute liver failure was present in 5 (35.7%) patients. Overall 90 day morbidity and mortality was 71.4% and 14.2%. Both mortalities were attributable to serious chest infection. No difference was observed in morbidity (21.3% versus 42.8%) (P = 0.3) and mortality rates (20% versus 11%) (P = 1.0) between patients with acute and chronic liver failure. Estimated 3 year survival was 85%.
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
EP05B-030 USABILITY OF CRYOPRESERVED AORTA HOMOGRAFTS FOR MIDDLE HEPATIC VEIN RECONSTRUCTION DURING LIVING DONOR LIVER TRANSPLANTATION S. -H. Kim, C. -S. Ahn, T. -Y. Ha, S. Hwang, D. -H. Jung, K. -H. Kim, S. -G. Lee, D. -B. Moon, G. -C. Park, G. -W. Song and W. -H. Kang Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine/Asan Medical Center, Republic of Korea 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.
EP05B-031 PORTAL VEIN STENTING IS A SIGNIFICANT RISK FACTOR FOR BILIARY STRICTURE IN ADULT LIVING DONOR LIVER TRANSPLANTATION: MATCHED CASECONTROL STUDY M. H. Shin, D. B. Moon, S. G. Lee, S. Hwang, K. H. Kim, C. S. Ahn, T. Y. Ha, G. W. Song, D. H. Jung, G. C. Park and Y. I. Yun Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Although perioperative portal vein (PV) stenting has been successfully performed to treat steno-occlusive
disease in adults undergoing living donor liver transplantation (LDLT), the incidence of biliary anastomotic stricture (BAS) after PV stenting was high. This matched case-control study was designed to clarify the relation between BAS and PV stenting, and to determine the mechanism of BAS and measures to reduce its incidence. Fortyfour LDLT recipients who underwent stenting crossing the PV anastomosis were classified as the Stent group and matched 1:3 with a Control, non-stented group (n = 131). The incidence of BAS was significantly higher in the Stent than in the Control group (43.2% versus 17.6%, p = 0.001). Cumulative 6 month and 1, 2, and 5 year BAS rates were 31.8%, 34.1%, 41.4%, and 43.2%, respectively, in the Stent group and 13.0%, 13.8%, 16.1%, and 17.8%, respectively, in the Control group (p = 0.001). Multivariate analysis showed that the size of the bile-duct (BD) opening, PV stenting, and acute cellular rejection were independent risk factors for BAS. A PV stent crossing the anastomosis may place extrinsic pressure on the adjacent peribiliary vascular plexus of the graft side, resulting in pressure-induced ischemic damage to the BD and BAS. In conclusion, PV stenting per se is an independent risk factor for BAS. Although PV stenting is a reliable and convenient modality in the treatment of steno-occlusive PV during adult LDLT, stent placement crossing the PV anastomosis should be avoided, even when indicated.
EP05B-032 PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION: A SINGLE CENTER EXPERIENCE FROM PAKISTAN F. S. Dar1, A. B. H. Bhatti1, S. Hashmi2, H. Zia1, M. I. Malik2, E. A. Khan3 and N. H. Shah4 1 HPB and Liver Transplantation, 2Pediatric Hepatology, 3 Pediatrics, and 4Transplant Hepatology, Shifa International Hospital, Pakistan Introduction: Outcome of pediatric living donor liver transplantation (LDLT) depends on multiple factors. In developing countries, lack of public awareness, restricted ancillary support services, limitations in technical expertise and a brittle healthcare system makes pediatric LDLT a daunting task. The objective of the current study was to report for the first time outcomes of pediatric LDLT recipients from Pakistan. Methods: All patients in pediatric age group (17 years) who underwent LDLT between April 2012 and April 2015 were included to ensure a minimum follow up of 3 months. In this period 14 pediatric LDLT’s were performed. We assessed all Grade 2 and above complications on ClavieneDindo grading system and included them as morbidity. For the purpose of this study, we assessed 90 day morbidity and mortality. Results: Median age was 8.5 years and ranged between 6 months and 17 years. Wilson disease (28.6%) and cryptogenic cirrhosis (28.6%) were the two most common aetiologies. Acute liver failure was present in 5 (35.7%) patients. Overall 90 day morbidity and mortality was 71.4% and 14.2%. Both mortalities were attributable to serious chest infection. No difference was observed in morbidity (21.3% versus 42.8%) (P = 0.3) and mortality rates (20% versus 11%) (P = 1.0) between patients with acute and chronic liver failure. Estimated 3 year survival was 85%.
HPB 2016, 18 (S1), e385ee601