FAILURE PATTERNS OF CRYOPRESERVED VEIN GRAFTS IN LIVER-TRANSPLANTATION

Reports of early success with cryopreserved saphenous veins (CSV) as a rterial conduits led us to develop cryopreserved iliac veins (CIV) as interposition grafts for portal vein reconstruction in living-related liver transplantation (LRLT) (4), Despite encouraging short-term resul ts, retrospective analysis of long-term cryopreserved vein graft perfo rmance in LRLT at our institution has revealed a high rate of late gra ft failure, Between July 1992 and July 1994, interposition grafts (CIV for portal vein interposition n = 4, CSV for portal vein interpositio n n = 3, and CSV for hepatic artery interposition n = 2) were utilized in 7 LRLT. (Two transplanted organs had both CIV and CSV grafts.) Rec ipients included 5 children and two small adults (median: 3.5 years, r ange: 0.5-59 years), Posttransplant follow-up in excess of 36 months r evealed portal vein (PV) and hepatic artery (HA) complications of cryo preserved grafts in each patient, PV complications included aneurysm ( n = 4) diagnosed at 28, 24, 18, and 1.5 mo, stricture (n = 1) diagnose d at 11 mo, and thrombosis (n = 1) diagnosed at 18 mo posttransplant, All portal vein complications have been managed without retransplantat ion, but one (PV thrombo sis) necessitated surgical shunt therapy, Eac h CSV hepatic artery interposition graft has been complicated by throm bosis (diagnosed at 11 days and 24 mo posttransplant) necessitating re transplantation. Based upon these observations, we have adopted altern ative strategies for HA and PV reconstruction, At present, 11 LRLT hav e been performed without cryopreserved vein conduits over 17 mo with n o vascular complications, While this study does mot permit statistical analysis, these results discourage the use of cryopreserved iliac vei ns for portal interposition and cryopreserved saphenous veins for arte rial interposition in liver transplantation.