Failure patterns of cryopreserved vein grafts in liver transplantation.
Failure patterns of cryopreserved vein grafts in liver transplantation.
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肝移植中冷冻静脉移植物的失败模式。
DOI：
10.1097/00007890-199609270-00007
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发表时间：
1996
期刊：
影响因子：
6.2
通讯作者：
J. Emond
中科院分区：
文献类型：
--
作者：
Anna A. Kuang;J. Renz;Linda D. Ferrell;Ernest J. Ring;Philip J. Rosenthal;Robert C. Lim;J. Roberts;N. Ascher;J. Emond
冷冻保存的隐静脉（CSV）作为动脉导管的早期成功报告促使我们开发冷冻保存的髂静脉（CIV）作为中间移植物，用于活体相关肝移植（LRLT）中门静脉重建。尽管短期结果令人鼓舞，但对我们机构 LRLT 中长期冷冻保存静脉移植物性能的回顾性分析显示，晚期移植物失败率很高。 1992年7月至1994年7月期间，7例LRLT使用了间置移植物（CIV用于门静脉介入，n=4，CSV用于门静脉介入，n=3，CSV用于肝动脉介入，n=2）。 （两个移植器官同时具有 CIV 和 CSV 移植物。）接受者包括 5 名儿童和两名小成人（中位年龄：3.5 岁，范围：0.5--59 岁）。超过 36 个月的移植后随访显示，每位患者均存在冷冻移植物的门静脉 (PV) 和肝动脉 (HA) 并发症。 PV 并发症包括移植后 28、24、18 和 1.5 个月诊断的动脉瘤 (n=4)、11 个月诊断的狭窄 (n=1) 和移植后 18 个月诊断的血栓 (n=1)。所有门静脉并发症均已得到控制，无需再次移植，但其中一种并发症（PV 血栓形成）需要手术分流治疗。每个 CSV 肝动脉介入移植物都因血栓形成而复杂化（在移植后 11 天和 24 个月诊断），需要再次移植。基于这些观察，我们采用了 HA 和 PV 重建的替代策略。目前，已实施 11 例 LRLT，时间超过 17 个月，无冷冻保存静脉导管，无血管并发症。虽然这项研究不允许进行统计分析，但这些结果阻止了在肝移植中使用冷冻保存的髂静脉进行门静脉介入和使用冷冻保存的隐静脉进行动脉介入。
Reports of early success with cryopreserved saphenous veins (CSV) as arterial conduits led us to develop cryopreserved iliac veins (CIV) as interposition grafts for portal vein reconstruction in living-related liver transplantation (LRLT). Despite encouraging short-term results, retrospective analysis of long-term cryopreserved vein graft performance in LRLT at our institution has revealed a high rate of late graft failures. Between July 1992 and JUly 1994, interposition grafts (CIV for portal vein interposition n=4, CSV for portal vein interposition n=3, and CSV for hepatic artery interposition n=2) were utilized in 7 LRLT. (Two transplanted organs had both CIV and CSV grafts.) Recipients included 5 children and two small adults (median: 3.5 years, range: 0.5--59 years). Posttransplant follow-up in excess of 36 months revealed portal vein (PV) and hepatic artery (HA) complications of cryopreserved grafts in each patient. PV complications included aneurysm (n=4) diagnosed at 28, 24, 18, and 1.5 mo, stricture (n=1) diagnosed at 11 mo, and thrombosis (n=1) diagnosed at 18 mo posttransplantation. All portal vein complications have been managed without retransplantation, but one (PV thrombosis) necessitated surgical shunt therapy. Each CSV hepatic artery interposition graft has been complicated by thrombosis (diagnosed at 11 days and 24 mo posttransplant) necessitating retransplantation. Based on these observations, we have adopted alternative strategies for HA and PV reconstruction. At present, 11 LRLT have been performed without cryopreserved vein conduits over 17 mo with no vascular complications. While this study does not permit statistical analysis, these results discourage the use cryopreserved iliac veins for portal interposition and cryopreserved saphenous veins for arterial interposition in liver transplantation.