Eligibility of Circumferential Fence With the Autologous Peritoneal Patch for Venous Reconstruction in Right Lobe Living-Donor Liver Transplant: A Case Control Study.

Objectives: : Our aim was to evaluate the eligibility of hepatic venous drainage technique using circumferential fence with peritoneal patch graft and saphenous vein graft in right lobe living-donor liver transplant.

Materials And Methods: Between November 2007 and December 2017, our center performed 1413 rightlobe living-donor liver transplants. A circumferential fence was created using the peritoneal patch graft for venous drainage reconstruction in 31 of these patients. We compared data of these 31 patients with data of 62 patients who had circumferential fence created with cryopreserved homologous saphenous vein graft (1:2 ratio). Patients with anastomotic stenosis (n = 10) and without anastomotic stenosis (n = 69) were also compared.

Results: No statistically significant differences were found between the peritoneal patch graft group and the saphenous vein graft group in terms of clinical parameters, circumferential fence diameter, and postoperative anastomotic stenosis (7.1% vs 26.1%; P = .056). Postoperative anastomotic stenosis developed in 10 patients. No statistically significant differences were found between patients with and without anastomotic stenosis in terms of clinical parameters except for diameter of circumferential fence (P = .001). Diameter of circumferential fence less than 18 mm in patients with and without anastomotic stenosis was shown in 80% and 34.6% of patients, respectively (P = .02). Stenosis-free survival in saphenous vein graft group was significantly better than in the peritoneal patch graft group (P = .023). Our correlation analyses showed a strong correlation between diameter of circumferential fence and the tenosis rate in patients (P = .001).

Conclusions: Autologous peritoneal patch graft can be used for creating circumferential fence for hepatic outflow in living-donor liver transplant patients if no better option is available. Despite high anastomotic stenosis rates, peritoneal fencing responded well to radiologic dilatation or stent applications and provided good long-term patency.