Living Donor Liver Transplantation With Vena Cava Replacement M.A. Yagci*, A. Tardu, S. Karagul, V. Ince, I. Ertugrul, S. Kirmizi, B. Unal, C. Aydin, C. Kayaalp, and S. Yilmaz Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey ABSTRACT Objectives. This study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). Materials and Methods. We performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. Results. Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n ¼ 5, IVC n ¼ 4, iliac vein n ¼ 1) or synthetic graft (n ¼ 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). Conclusions. Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency. D ESPITE development of new surgical techniques in living donor liver transplantation (LDLT), occlusion of the inferior vena cava (IVC) remains a surgical challenge. The main reasons are iatrogenic injury, chronic post- thrombotic or membranous occlusion, and malign or benign liver diseases, including hepatocellular carcinoma, hepato- blastoma, and Echinococcus alveolaris [1e5]. To obtain sufficient hepatic venous outflow in these cases, resection of IVC is required. Compared with whole-liver transplantation in which the IVC of the deceased donor is available, the selection of vessel grafts to be used as a substitute is crucial for IVC reconstruction during LDLT. When the resultant defect is only a small area, it is possible to perform cavoplasty [6]. However, when the inferior vena cava is stenotic and fibrotic or a metallic stent has been implanted in the diseased IVC during previous intervention, IVC replacement becomes necessary [7]. Autologous, cryopreserved and prosthetic grafts have been used successfully, as reported in the literature [1e7]. Herein we present our experience of IVC resection and reconstruction with the use of different grafts in patients undergoing LDLT. The aim of this study was to evaluate indications, techniques, and the outcomes of patients after an aggressive surgical approach of IVC resection and reconstruction in LDLT. MATERIALS AND METHODS Data were derived from a prospectively collected database at the Turgut Ozal Medical Center of Inonu University from November 2009 to August 2014. We performed 821 LDLTs in 812 patients suffering from end-stage liver disease at our center. We investigated transplant patient characteristics including original liver disease, Model for End-Stage Liver Disease and Child-Pugh score, and indi- cation for IVC replacement. Other examined features consisted of *Address correspondence to Mehmet Ali Yagci, MD, Depart- ment of Surgery, Turgut Ozal Medical Center, Inonu University, Malatya, 44315, Turkey. E-mail: maliyagci@gmail.com ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.04.019 Transplantation Proceedings, 47, 1453e1457 (2015) 1453