Prosthetic Graft Migration in Living Donor Liver Transplantation: A Case for Conservative Management?

Abstract

A 61-year-old male underwent living donor liver transplantation (LDLT) for decompensated chronic liver disease with hepatocellular carcinoma. The right lobe from the live donor was used as the graft. During implantation, the drainage of the anterior sector of the right lobe graft was through a reconstructed middle hepatic vein using a prosthetic polytetrafluoroethylene (PTFE) graft. Routine follow-up at 6 weeks showed a thrombosed PTFE graft with no clinical, radiological, or biochemical deterioration of the allograft. He was therefore managed conservatively. A routine computed tomography scan at 2 years demonstrated that the PTFE graft had eroded into the duodenum. Given the total absence of symptoms and the risk of complications associated with removing the graft, we decided against any surgical or endoscopic intervention. After a further 3 year period of follow-up, the patient continues to remain well. Enteric erosion of a prosthetic graft following LDLT can be managed without intervention, although long-term consequences are unknown.

Keywords

• graft migration
• living donor liver transplantation
• polytetrafluoroethylene