Use of banked cryopreserved veins from explanted recipient livers in living donor liver transplantation


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Abstract

Background.In living donor liver transplantation, variations in donor vascular anatomy, recipient portal vein thrombosis, short donor vessel length, and reconstitution of the anterior sector outflow in right lobe grafts often make complex and innovative vascular reconstructions necessary, which require the use of extension vascular conduits. Commonly used grafts are cryopreserved vessels from deceased donors, or obtained from the recipient or the live liver donor. Faced with paucity of deceased donor vessels, and to avoid the use of live donor veins in patients with malignancy or unusable intrahepatic veins, we have started using cryopreserved veins harvested from explanted livers of other recipients of the same blood group who had no transmissible infection or intrahepatic malignancy.Methods.All veins were carefully harvested by meticulously ligating tributaries tested for leaks, hydrostatically distended with heparin before cryopreservation in liquid nitrogen and thawed gradually before use.Results.Out of 6 patients, cryopreserved veins were used: to reconstruct the anterior sector outflow of the extended right lobe graft in 4 patients; to reconstruct an aberrant 2 vein of a left lateral segment graft in 1; and to extend a short right portal vein in the other patient. Intraoperative and serial Doppler studies revealed patent anastomoses with good flow velocity with a mean follow-up of 7 months (range, 4-12 months).Conclusions.Cryopreserved veins from explanted diseased livers are an important and previously untapped source of extension grafts that have good medium-term patency rates.

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