Abstract:
Objectives. This study sought to evaluate the indications, techniques, and results of
inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT).
Materials and Methods. We performed 821 LDLTs and 11 (1.3%) patients required
concomitant IVC replacement. We analyzed the indications, replacement materials, and
outcomes.
Results. Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients,
respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients
(Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1),
involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and
iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n ¼ 5, IVC n ¼ 4,
iliac vein n ¼ 1) or synthetic graft (n ¼ 1) were used for replacements. In 1 patient, hepatic
outflow obstruction developed at 39 days and was treated successfully by interventional
radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval
replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were
patent after a mean 7.7 months of follow-up (range 1 to 17 months).
Conclusions. Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and
E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement
with cryopreserved vascular grafts can provide successful short-term and long-term patency.
