GSV conduits were used for hepatic arterial reconstruction in 21 patients undergoing LDLT when the native hepatic artery was deemed unsuitable. While GSV conduits showed excellent patency rates, patients with GSV conduits had higher mortality compared to those reconstructed with native arteries. The higher mortality in the GSV group was attributed to a high rate of failure to rescue patients who developed biliary complications, as well as bleeding requiring laparotomy. Though GSV conduits may be a viable option for arterial reconstruction in rescue situations, larger multicenter studies are still needed.

1. Saphenous vein conduits for
hepatic arterial reconstruction
in living donor liver
transplantation

2. Introduction
• In LDLT, vascular complications are associated with significant
morbidity and mortality.
• Occasionally, an intraoperative event such as intimal dissection during
recipient hepatectomy renders native recipient hepatic artery
unsuitable for reconstruction.
• Scarring from previous surgery or poor caliber from repeated
transarterial chemoembolization (TACE) procedures also increases
this risk

3. Introduction
• Arterial reconstruction in such a situation can be performedwith
extra-anatomic conduits
• Most frequently used conduits include right gastric artery (RGA), right
gastroepiploic artery (RGEA), left gastric artery (LGA), and splenic
arteries (SA)

4. Introduction
• In pure LDLT centers, great saphenous vein (GSV) interposition
conduits might be a viable alternative
• The objective of this study was to compare outcomes for patients
who underwent hepatic arterial reconstruction using native hepatic
arteries with patients who had GSV interposition conduits for arterial
reconstruction.

5. Material and methods
Prospective maintained database study was done at Shifa international hospital
Islamabad Between April 2012 and September 2017.
Inclusion criteria
• All adult patient who underwent LDLT
Exclusion criteria
Pediatric liver transplant
• Liver transplant for acute liver failure

6. Procedure
During recipient hepatectomy
High hilar dissection was performed
Dissection continued to proper hepatic artery
if unsuitable native hepatic artery
Common hepatic artery and splenic artery assessed for reconstruction
If CHA and SA are also unsuitable

7. 18 – 20 cm of left great saphaneous vein was procured

8. Aortohepatic
conduit created Retrocolic ante pancreatic
Proline 6-0 used as suture material

9. Intraoperative Doppler study
Followed by daily liver Doppler study
For conduits they used intravenous heparin
For all other patient they used LMWX

10. TOTAL PATIENTS (473)
GROUP 1
(452)
GROUP 2
(21)

11. Aim
• The two groups were compared for demographics, and graft and
operative variables
• The outcome was assessed based on the rate of hepatic artery
thrombosis (HAT), early allograft dysfunction (EAD) , morbidity, and
mortality

12. STATISTICS
• For interval variables, t test or Mann Whitney U test was used.
• For categorical variables, Fisher’s exact test and chi square test were
used.
• Survival was calculated using Kaplan Meier curves and log-rank test.
• A P value < 0.05 was considered statistically significant.
• Overall survival was calculated by subtracting date of last follow
up/death from date of surgery.

13. RESULTS

14. RESULTS

15. RESULTS

16. RESULTS

17. RESULTS

18. RESULTS

19. DISCUSSION
• The GSV conduits showed excellent patency rates but were associated
with high patient mortality
• There was a high rate of failure to rescue (FTR) in patients who had a
biliary complication in the GSV group
• Postoperative bleeding mandating a laparotomy led to mortality in
25% patients with GSV conduits
• In their experience, in presence of hepatic artery dissection, the
integrity of nearby arteries is often questionable.
• Is one of the conduit of choice in rescue situation.

20. Article review
• largest experience with the use of GSV conduits in LDLT.
• Latest article
• Relevant to our center as we are live donor liver transplant center.

21. Cons
• Small no of patient
• Published in journal with impact factor 2.191
• Single institution study
• Randomised control trial comparing with other conduit required