Hsu Shih-Chao, Thorat Ashok, Yang Horng-Ren, Poon Kin-Shing, Li Ping-Chun, Yeh Chun-Chieh, Chen Te-Hung, Jeng Long-Bin
Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
Med Sci Monit. 2017 Jul 6;23:3284-3292. doi: 10.12659/msm.902636.
BACKGROUND Our recent studies have highlighted the importance and safety of backtable venoplasty for middle hepatic vein (MHV) and inferior right hepatic veins (IRHV) reconstruction using expanded polytetrafluoroethylene (ePTFE) vascular grafts. In this study, we aim to analyze the complications associated with ePTFE graft use and discuss the management of the rare, but, potentially life threatening complications directly related to ePTFE conduits. MATERIAL AND METHODS From January 2012 to October 2015 a total of 397 patients underwent living donor liver transplantation (LDLT). The ePTFE vascular grafts were used during the backtable venoplasty for outflow reconstruction in 262 of the liver allografts. Recipients who developed ePTFE-related complications were analyzed. RESULTS ePTFE-related complications developed in 1.52% (4/262) of the patients. One patient (0.38%) developed complete thrombosis with sepsis at 24 months post-transplantation and died due to multiorgan failure. Three patients (1.1%) developed graft migration into the second portion of the duodenum, without overt peritonitis. Surgical exploration and ePTFE graft removal was done in all the patients. One patient died due to overwhelming sepsis. CONCLUSIONS ePTFE graft migration into the duodenum causing perforation is a new set of complications that has been recently described in LDLT and can be treated effectively by surgical removal of the infected vascular graft and duodenal perforation closure. Despite of such complications, in our experience, ePTFE use in LDLT continues to have wide safety margin, with a complication rate of only 1.52%.
背景 我们最近的研究强调了使用膨体聚四氟乙烯（ePTFE）血管移植物进行肝后下腔静脉成形术重建肝中静脉（MHV）和右下肝静脉（IRHV）的重要性和安全性。在本研究中，我们旨在分析与使用ePTFE移植物相关的并发症，并讨论与ePTFE导管直接相关的罕见但可能危及生命的并发症的处理方法。材料与方法 2012年1月至2015年10月，共有397例患者接受了活体肝移植（LDLT）。其中262例同种异体肝移植在肝后下腔静脉成形术期间使用了ePTFE血管移植物。对发生ePTFE相关并发症的受者进行了分析。结果 1.52%（4/262）的患者发生了ePTFE相关并发症。1例患者（0.38%）在移植后24个月发生完全血栓形成并伴有脓毒症，因多器官功能衰竭死亡。3例患者（1.1%）发生移植物移入十二指肠第二段，无明显腹膜炎。所有患者均进行了手术探查并取出ePTFE移植物。1例患者因严重脓毒症死亡。结论 ePTFE移植物移入十二指肠导致穿孔是最近在LDLT中描述的一组新并发症，通过手术切除感染的血管移植物并闭合十二指肠穿孔可有效治疗。尽管有此类并发症，但根据我们的经验，LDLT中使用ePTFE仍具有广泛的安全范围，并发症发生率仅为1.52%。
