Karaciğer Naklinde Middle Hepatik Ven ve Sağ İnferior Hepatik Ven Rekonstrüksiyonunda Polytetrafluoroethylene (PTFE) Greft Kullanımı ve Tıkanmama Oranları: Üç Yıllık Sonuçlarımız

Öz

Amaç: Canlı Vericili Karaciğer Nakli (CVKN)’nde, modifiye sağ lob takılan hastalarda kullanılan Polytetrafluoroethylene (PTFE) greftlerin zamana göre açık kalma oranları değerlendirilmiştir. Ayrıca açık kalma oranını etkileyen faktörler, erken tıkanma sonrası gelişebilecek sorunlar ve olası greft ilişkili komplikasyonlar incelenmiştir. Materyal ve Metod: 2013-15 yıllarında ameliyat edilen, yaşları 17-74 arasında değişen 168 hasta çalışmaya dahil edildi. Postoperatif takiplerde çekilen Multislice Bilgisayarlı Tomografi (MSBT)’lerin venöz fazları retrospektif olarak incelendi. Hastalara kullanılan PTFE greftlerin tıkanma zamanları ve bu greftlerin drene ettiği segmentteki konjesyon durumu değerlendirildi. Greft ilişkili komplikasyonlar, Greft Alıcı Ağırlık Oranı (GAAO) değerleri ve postoperatif 1 aylık laboratuar bulguları da çalışmaya dahil edildi. Bulgular: Kullanılan PTFE greft açık kalma oranlarının, kriyopresipiye greft çalışmalarıyla kıyaslandığında, daha düşük olduğu görüldü. Greft lokalizasyonuyla açık kalma süreleri arasında anlamlı farklılık bulunmadı. Hastaların boy, kilo, BMI, karaciğer greft ağırlığı (KGA) ve greft alıcı ağırlık oranı (GAAO) ile ilk konjesyon, ilk tıkanma ve tüm venlerin tıkandığı zaman arasında anlamlı korelasyon bulunmadı. GAAO değerleri ile takiplerde tromboze olan greftlerin açık kalma zamanları arasında korelasyon tespit edildi. Kullanılan PTFE greft çapı ile açık kalma süresi arasında anlamlı ilişki bulunmadı. Transplantasyon nedenlerine göre açık kalma durumuna da bakıldı ancak anlamlı bir fark bulunmadı. Sonuç: PTFE greftler erken dönem açık kalma oranlarının yüksek olması nedeniyle, kriyopresipiye greftlerin bulunmadığı şartlarda ancak mevcut komplikasyon potansiyelleri akılda tutularak rekonstrüksiyon amaçlı olarak kullanılabilir.

Anahtar Kelimeler

• Karaciğer Nakli
• Middle Hepatik Ven
• Polytetrafluoroethylene Greft

Use of Polytetrafluoroethylene Graft in Reconstruction of Middle Hepatic Vein and Right Inferior Hepatic Vein in Liver Transplantation and Rate of Non-Thrombosis of the Vein Our Three-Year Results

Öz

Objective: The patency rate of Polytetrafluoroethylene (PTFE) grafts used in patients with modified right lobe implants in Living Donor Liver Transplantation (CVKN) was evaluated over time. In addition, factors affecting patency rate, problems that may develop after early occlusion, and possible graft-related complications were examined. Materials and Methods: 168 patients aged between 17-74 who underwent surgery in 2013-15 were included in the study. Venous phases of Multislice Computed Tomography (MSCT) taken during postoperative follow-ups were analyzed retrospectively. The occlusion times of the PTFE grafts used in the patients and the congestion in the segment drained by these grafts were evaluated. Graft-related complications, Graft Recipient Weight Ratio (GAAO) values, and postoperative 1-month laboratory findings were also included in the study. Results: The patency rate of the PTFE graft used was lower when compared to the cryoprecipitated graft studies. There was no significant difference between graft localization and patency time. There was no significant correlation between the patients' height, weight, BMI, liver graft weight (KGA) and graft recipient weight ratio (GAAO) and initial congestion, first occlusion, and time of all vein occlusion. A correlation was found between GAAO values and patency times of thrombosed grafts during follow-up. There was no significant relationship between the PTFE graft diameter used and the patency time. The patency status according to the reasons for transplantation was also examined, but no significant difference was found. Conclusion: Due to the high early patency rate of PTFE grafts, they can be used for reconstruction purposes only in the absence of cryoprecipitated grafts, but keeping in mind the current complication potential.

Anahtar Kelimeler

• Liver Transplantation
• Middle Hepatic Vein
• Polytetrafluoroethylene Graft

Kaynakça

1. 1. Hwang S, Lee SG, Lee YJ. Lessons learned from 1000 living donor liver transplantation in a single center: How to make living donation safe. Liver Transpl. 2006; 12(6):920-7.
2. 2. Fan ST, Lo CM, Liu CL, Wang WX, Wong J. Safety and ne-cessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplanta-tion. Ann Surg. 2003; 238(1):137-48.
3. 3. Fan ST, De Villa VH, Kiuchi T, Lee SG, Makuuchi M. Right anterior sector drainage in right-lobe live-donor liver transplantation. Transplantation. 2003; 75(3):25-27.
4. 4. Inomata Y, Uemoto S, Asonumo K, Egava H. Right lobe graft living donor liver transplantation. Transplantation. 2000; 69(2):258-64.
5. 5. Lee SG. Asian contribution to living donor liver transplan-tation. J Gastroenterol Hepatol. 2006; 21(3):572-74.
6. 6. Yu PF, Wu J, Zheng SS. Management of the middle hepat-ic vein and its tributaries in right lobe living donor liver transplantation. Hepatobiliary Pancreat Dis Int. 2007; 6(4):358-63.
7. 7. Lee S, Park K, Hwang S, et al. Anterior segment conges-tion of a right liver lobe graft in living-donor liver trans-plantation and strategy to prevent congestion. J Hepato-biliary Pancreat Surg. 2003; 10(1):16-25.
8. 8. Couinaud C. Schema general de la distribution intra-hepatique. In: Couinaud C, ed. Le foie. Etudes anatomiques et chirurgicales. Paris: Massaon & Cie; 1957: 9–12.

9. 9. Lee SG, Park KM, Hwang S, et al. Adult-to-adult living do-nor liver transplantation at Asian Medical Center, Seoul, Korea. Transplant Proc 1999; 31(1-2):456–58.
10. 10. Hwang S, Jung DH, Ha TY, et al. Usability of ringed polytet-rafluoroethylene grafts for middle hepatic vein recon-struction during living donor liver transplantation. Liver Transpl 2012; 18(8):955-65.
11. 11. Yi NJ, Suh KS, Lee HW, et al. An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation. Liver Transpl 2007; 13(8):1159-67.
12. 12. Pomposelli JJ, Akoad M, Khwaja K, et al. Evolution of an-terior segment reconstruction after live donor adult liver transplantation: a single-center experience. Clin Trans-plant 2012; 26(3):470-75.
13. 13. Sugawara Y, Makuuchi M. Advances in adult living donor liver transplantation: a review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in Tokyo. Liver Transpl 2004; 10(6): 715-20.
14. 14. Sano K, Makuuchi M, Miki K, et al. Evaluation of hepatic venous congestion: proposed indication criteria for he-patic vein reconstruction. Ann Surg 2002; 236(2): 241-47.
15. 15. Asakuma M, Fujimoto Y, Bourquain H, et al. Graft selec-tion algorithm based on congestion volume for adult living donor liver transplantation. Am J Transplant 2007; 7(7):1788-96.
16. 16. Kyoji Ito, Nobuhisa Akamatsu, Keigo Tani, et al. Recon-struction of Hepatic Venous Tributary in Right Liver Living Donor Liver Transplantation: The Importance of the Infe-rior Right Hepatic Vein. Liver Transpl 2016; 22(4): 410-19.
17. 17. Lee SG, Park GM, Hwang S, Kim KH, Choi DN, Joo SH, et al. Modified right liver graft from a living donor to prevent congestion. Transplantation 2002; 74(1):54-9.