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KHBPS 2016.04.01

This study explores the resolving mechanisms of hepatic venous congestion (HVC) after occlusion of the middle hepatic vein interposition graft (IG) post-liver transplantation. Through retrospective cohort analysis, the research delves into collateral formation, occlusion patterns, and resolution timings. Findings suggest the importance of preserving IG patency post-transplant to prevent severe ischemia and HVC.

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KHBPS 2016.04.01

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  1. Resolving Mechanisms of Hepatic Venous Congestion Following Progressive Occlusion of Middle Hepatic Vein Interposition Graft KHBPS 2016.04.01 Varvara A Kirchner, Shin Hwang, Gi-Won Song, Chul-Soo Ahn, Deok-Bog Moon, Ki-Hun Kim, Dong-Hwan Jung, Tae-Yong Ha, Gil-Chun Park, Sung-Gyu Lee Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea Department of Surgery, Division of Transplantation, University of Minnesota, USA

  2. Background • Middle hepatic vein (MHV) interposition graft (IG) is often occluded within a few months after LDLT. • Slow occlusion of MHV-IG may induce new collaterals between the segmental branches of MHV and RHV Lee et al. Surgery 2000

  3. Objectives - To understand the mechanisms associated with the progressive occlusion of MHV-IG - To investigate the resolving mechanism of hepatic venous congestion (HVC) following progressive occlusion of MHV-IG

  4. Study Design Retrospective cohort study using serial follow-up CT scans Part I – Donors: (n=100) - To study spontaneous resolving mechanisms of HVC within remnant right liver(RL) after donation of extended left liver (LL) Part II – Recipients: (n=100) • To study the resolution of HVC within RL graft following progressive occlusion of cryopreserved iliac vein MHV-IG • To study mechanisms, pattern and timing of MHV-IG occlusion

  5. Results Part I:Presence of innate MHV branches-RHV collaterals No HVC in 8% of extended LL donors Pre-donation CT 1-week CT

  6. Results - Continued Part I:Neo-collateralization between MHV branches-RHV Arterial phase Venous phase Pre-donation CT 1-week CT Early Compensation 44% No Early Compensation 48%

  7. Part I:Summary • Pre-existing innate MHV-RHV collaterals were present in only 8% of donors • Early compensatory collaterals developed in 44% of donors - Acute MHV segmental branch occlusion induced ischemic HVC in 48% of donors

  8. Part II: MHV-IG Occlusion in RecipientsImplicationsTimingMechanismsPattern

  9. Results Congestion Part II: Implications of Early Complete or Partial MHV-IG or Segmental Branches Occlusions in Recipients Congestion / Ischemia Severe Ischemia

  10. Results Part II: Timing of MHV-IG Occlusion

  11. Results 1. Extrinsic Compression of the Graft 2. Intrinsic Narrowing of the Graft Part II: Mechanisms of MHV-IG Occlusion

  12. Results Acute Thrombosis MHV-IG Part II: Patterns of MHV-IG Intrinsic Occlusion Contributes to Low-Flow State within a Graft Narrowing of Reconstructed V8 Branches Collateral Formation

  13. Results Part II:

  14. Results Collateral Expansion and Neocollateralization Neocollateralization Part II:

  15. Results Part II: Correlation between IG Occlusion and New Collateral Development

  16. Conclusions • HVC from acute MHV occlusion was not tolerated in more than half of liver donors and required more than 1 month for its resolution. • Late progressive occlusion of MHV-IG was well tolerated through development of intrahepatric collaterals. • We suggest that MHV-IG should maintain its patency for at least 6 months after LT.

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