Long-Term Patency of Hemashield Vascular Grafts Used for Middle Hepatic Vein Reconstruction During Living-Donor Liver Transplantation: A Single-Center Korean Experience

BACKGROUND The availability of homologous vein allografts is limited. Therefore, prosthetic vascular grafts can be used as alternatives for middle hepatic vein (MHV) reconstruction during living-donor liver transplantation (LDLT). This study evaluated the short- and long-term patency of MHV reconstructions using Hemashield vascular grafts and assessed their effect on post-transplant survival. MATERIAL AND METHODS This retrospective observational study included 149 adult LDLT recipients who underwent MHV reconstruction using Hemashield grafts at a single institution. Graft patency and survival outcomes were assessed over long-term follow-up. RESULTS The mean recipient age was 56.2±7.7 years, and the mean graft-to-recipient weight ratio was 1.06±0.25. V5 reconstruction was achieved through single, double, and triple anastomoses in 111, 32, and 2 patients, respectively. V8 reconstruction in 116, 20, and one patient was achieved through single, double, and triple anastomoses, respectively. In 100 and 49 cases, we used Hemashield grafts with diameters of 10 mm and 12 mm, respectively. Three patients (2.0%) developed early thrombosis that necessitated stent placement. The cumulative conduit occlusion-free survival rates were 81.0% at 3 months, 57.9% at 1 year, 48.7% at 3 years, and 43.8% at 5 years. Overall patient survival rates were 95.3% at 1 year, 89.1% at 3 years, and 85.7% at 5 years. No cases of graft migration or conduit-related infection were identified. CONCLUSIONS MHV reconstruction using Hemashield grafts demonstrated acceptable short- and long-term patency, with no migration or infection. These findings support the use of Hemashield grafts as a reliable and effective prosthetic option for MHV reconstruction during LDLT.