Abstract
In living-donor liver transplantation, only a portion of the donor’s liver is grafted into the recipient; therefore, if the hepatic vein and inferior vena cava (IVC) in the recipient fail to be transformed or dilated properly, it could cause inadequate blood flow from the liver graft to the IVC. We have developed an easy-to-use tissue engineered patch that can be used for the reconstruction of the hepatic vein and IVC. Five hybrid pigs (weighing 15–30 kg) served as the recipients of the patch. A bioabsorbable polymer sheet was used to produce the patch, with no cells seeded. The pigs were laparotomized, followed by the removal of a 3 × 2-cm portion of the infrahepatic IVC, which was then patched with the polymer sheet. Three months after the operation, the graft site was removed and subjected to gross and histologic examinations. All five pigs survived until they were killed 3 months after the operation. On gross examination, the polymer sheet grafted onto the IVC was completely absorbed, and the graft site was morphologically similar to the native IVC. In all five pigs, the patched IVC was free of stenosis or deformation. Immunohistochemical examination revealed that the patch site was lined with endothelial cells and that smooth muscle was present under the epithelium. Like the native IVC, the patch site tested positive for factor VIII. These findings suggest that this polymer sheet may be useful for the reconstruction of the IVC and hepatic vein during living-donor liver transplantation in humans.
Similar content being viewed by others
References
Yamanaka J, Imamura M, Kuroda N, Hirano T, Fujimoto J. Hepatic venoplasty to overcome outflow block in living transplantation. J Pediatr Surg 2004;39:1128.
Arii S, Teramoto K, Kawamura T, et al. Significance of hepatic resection combined with inferior vena cava resection and its reconstruction with expanded polytetrafiuoroethylene for treatment of liver tumors. J Am Coll Surg 2003;196:243–249.
Sugawara Y, Makuuchi M, Akamatsu N, et al. Refinement of venous reconstruction using cryopreserved veins in right liver grafts. Liver Transpl 2004;10:541–547.
Pilly SP, Lynch S, Strong RW, Ong TH, Kawamoto S, Yamanaka J. Use of the donor iliac vein to replace the retrohepatic vena cava in pediatric reduced-size liver retransplantation. J Pediatr Surg 1995;30:1698–1699.
Hirohashi K, Shuto T, Kubo S, et al. Asymptomatic thrombosis as a late complication of a retrohepatic vena caval graft performed for primary leimyosarcoma of the inferior vena cava: Report of a case. Surg Today 2002;32:1012–1015.
Kenny DA, Berger K, Walker MW. Experimental comparison of the thrombogenesity of fibrin and PTFE flow surface. Ann Surg 1980;191:355–361.
Kaihara S, Kim S, Benvenuto M, et al. End-to-end anastomosis between tissue-engineered intestine and native small bowel. Tissue Eng 1999;5:339–346.
Simmons CA,Alsberg E, HsiongS,KimWJ,Mooney DJ. Dual growth factor delivery and controlled scaffold degradation enhance in vivo bone formation by transplanted bone marrow stromal cells. Bone 2004;35:562–569.
Shin’oka T, Imai Y, Ikada Y. Transplantation of a tissueengineered pulmonary artery. N Engl J Med 2001;344:532–533.
Teebken OE, Haverich A. Tissue engineering of small diameter vascular grafts. Eur J Vasc Endovasc Surg 2002;23:475–485.
Kumar TR, Krishnan LK. A stable matrix for generation of tissue-engineered nonthrombogenic vascular grafts. Tissue Eng 2002;8:763–770.
Noishiki Y, Tomisawa Y, Yamane Y. Autocrine angiogenetic vascular prosthesis with bone marrow transplantation. Nat Med 1996;2:90–93.
Jernigan TW, Croce MA, Cagiannos C, Shell DH, Handorf CR, Fabian TC. Small intestinal submucosa for vascular reconstruction in the presence of gastrointestinal contamination. Ann Surg 2004;239:733–738.
Taveau JW, Tartaglia M, Buchannan D, et al. Regeneration of uterine horn using porcine small intestinal submucosa grafts in rabbits. J Invest Surg 2004;17:81–92.
Abbott A, Cyranoski D. Biologists seek to head off future sources of infection. Nature 2003;423:3.
EI-Assmy A, Hafez AT, EI-Sherbiny MT, et al. Use of single layer small intestinal submucosa for long segment ureteral replacement: A pilot study. J Urol 2004;171:1939–1942.
Hattori K, Tomita N, Tamai S, Ikada Y. Bioabsorbable thread for tight tying of bones. J Orthop Sci 2000;5:57–63.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was supported by a grant (16790758) from the Ministry of Education, Culture, Sports, Science and Technology, Japan.
Rights and permissions
About this article
Cite this article
Toshimitsu, Y., Miyazawa, M., Torii, T. et al. Tissue-engineered patch for the reconstruction of inferior vena cava during living-donor liver transplantation. J Gastrointest Surg 9, 789–793 (2005). https://doi.org/10.1016/j.gassur.2005.03.007
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2005.03.007