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Abstract
Purpose
Most of grafts used as interposition conduits for middle hepatic vein (MHV) in living donor liver transplantation (LDLT) have been allografts and autografts. Recently, polytetrafluoroethylene (PTFE) and bovine pericardium patch have also been used. Thus, we performed large-animal lab tests to assess the feasibility of interposition vessel graft substitutes for MHV.
Methods
The inferior vena cava was replaced in 9 dogs with allograft (3), PTFE (3), and bovine pericardium patch (3). After 28 days, patency rate, outer and inner diameter, intimal thickness, histology, and immunohistochemistry were evaluated according to interposition grafts.
Results
The allograft and PTFE groups were all patent at post-operative week 4, but the bovine group was not patent in all dogs. Outer diameter of anastomotic site at 4 weeks was 8.41±0.37, 10.83±0.51, and 7.41±0.86 mm in allograft, PTFE, and bovine group, respectively. Inner diameter of interposition graft at 4 weeks was 7.90±0.23, 6.33±0.68, and 0 mm in allograft, PTFE, and bovine groups, respectively. Intimal thickness was 48.0±8.6, 113.8±45.3, and 218.3±59.9µm in allograft, PTFE, and bovine groups, respectively. In histologic findings, inflammation was most severe in the bovine group. Intima of anastomotic site in the bovine group was thickest in all groups. Proliferation of smooth muscle cells was most severe in anti-alpha-actin antibody test in bovine group.
Figures and Tables
Fig. 1
Anastomosis of interposition vessel grafts to inferior vena cava. (A) Allograft (B) polytetrafluoroethylene graft. (C) Bovine pericardium patch graft. All anastomosis of interposition vessel grafts were securely completed.
Fig. 2
Measurement of outer diameter of anastomotic site. (A) Allograft. (B) PTFE graft. Anastomotic site is slightly narrowed but patency is preserved in both (A) and (B) grafts. (C) Bovine pericardium graft. Anastomotic site (arrow heads) is completely obstructed and collateral vessels (arrows) are developed.
Fig. 3
Cross-section and longitudinal section of PTFE and bovine pericardium graft specimen at four weeks postoperatively. (A) Cross-section of PTFE graft. (B) Longitudinal section of PTFE graft. There is thombosis in lumen of PTFE graft. However, patency of PTFE is preserved. (C) Cross-section of bovine pericardium patch graft. The lumen of bovine pericardium patch graft is completely obstructed by thrombus. (D) Longitudinal section of bovine pericardium patch graft. Recipient vessel wall of Anastomotic site looks very thick and vessel lumen is completely obstructed (arrows).
Fig. 4
Longitudinal section of allograft around the anastomotic site. (A) Anastomotic site between recipient inferior vena cava and allograft. (B) Recipient's vena caval wall next to anastomotic site. (C) Allograft vessel wall. Red blood cells (arrowheads) and inflammatory cells (arrows) like polymorphonuclear neutrophils, lymphocytes are infiltrated into media and new vessels (dotted arrows) are also shown in media layer. Inflammatory reaction is most active around anastomotic site (Hematoxylin and eosin stain, original magnification ×100, bar=0.05 mm).
Fig. 5
Intimal thickness in the allograft group. Intima of recipient vena caval wall next to the anastomotic site (A) is thicker than that of interposition allograft wall (B). Smooth muscle cells are red color in Masson's trichrome stain (arrows) (Masson's trichrome stain, original magnification ×100, bar=0.05 mm).
Fig. 6
Intimal thickness in the PTFE group. Intima of anastomotic site between recipient vena cava and PTFE is thicker than allograft group. Note focal thickness site (arrows) (Masson's trichrome stain, ×25, bar=0.1 mm).
Fig. 7
Longitudinal section of bovine pericardium graft around anastomotic site. Inflammation is most severe in bovine group. There is numerous fibroblasts and collagenous fibers proliferation (A. Hematoxylin and eosin, B. Verhoeff-Van Gieson stain, ×25, bar=0.1 mm).
Fig. 8
Intimal thickness in the bovine pericardium group. Intima of anastomotic site between recipient vena cava and bovine pericardium patch graft is thickest in all groups and neovascularization (arrows) develops around obstructed lumen (arrowheads) (Masson's trichrome stain, ×25, bar=0.1 mm).
Fig. 9
Immunohistochemistry using anti-proliferating cell nuclear antigen (PCNA) antibody. There is nearly no positive cell in allograft group (A). There are small numbers of positive cells in PTFE group (B). PCNA positive cells are most abundant in bovine group (C, D) (×25, bar=0.1 mm).
Fig. 10
Immunohistochemistry using anti-alpha-actin antibody. Smooth muscle cell lining in the intima of the allograft group is scanty (A). PTFE group (B) is thicker than allograft group in thickness of intimal wall. Bovine pericardium patch group (C) shows thickest wall in all groups (×25, bar=0.1 mm).
Fig. 11
Immunohistochemistry using anti-von Willebrand Factor antibody. Endothelial cells line in lumen of allograft (A), PTFE (B), and bovine pericardium patch group (C) (×25, bar=0.1 mm).
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