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Abstract
In right-lobe living-donor liver transplantation (LDLT), adequate venous outflow of the anterior sector (V5/V8 tributaries) is critical to prevent congestion and early graft dysfunction. The choice of conduit for V5/V8 outflow reconstruction with creation of a neo-middle hepatic vein (MHV) remains a practical limitation, especially in the setting of a shortage of deceased-donor vascular allografts. The aim of this study was to describe the technical feasibility and early patency of a modified allogeneic great saphenous vein (GSV) cold-stored in custodiol and to explore its outcomes relative to recipient portal vein and prosthetic conduit cohorts. We conducted a retrospective single-center comparative cohort study covering the period from 2014 to 2025. Adult recipients aged 18-60 years who underwent right-lobe LDLT with V5 and/or V8 outflow reconstruction using a neo-MHV conduit were included: recipient PV (n = 63), prosthesis (n = 11), modified GSV (n = 16). The primary endpoint was obstruction of the re-constructed V5/V8 outflow through the neo-MHV conduit within 45 days, classified as early (≤ 7 days) or late ( > 7 days). Patency was assessed by serial Doppler ultrasound and/or contrast-enhanced imaging. Time-to-event analysis was performed using the Kaplan-Meier method. Overall outflow obstruction within 45 days was observed in 25.4% of the recipient PV group, 45.5% of the prosthesis group, and 6.2% of the modified GSV group (p = 0.063). In an exploratory Firth logistic regression adjusted for calendar year and selected baseline and graft characteristics, the overall association between conduit type and 45-day outflow obstruction was not statistically significant (p = 0.318). The probability of obstruction-free patency on day 7 was 0.804, 0.727, and 0.938, respectively; by day 45, it was 0.733, 0.468, and 0.938, respectively. Observed group-level differences included shorter cold ischemia time (38 [35; 42] min; p = 0.001), a shorter anhepatic period (42 [26; 61] min; p < 0.001), and lower blood loss (1,200 [775; 1,500] mL; p = 0.006) in the modified GSV group. Postoperative hospital stay was also shorter (18 [15; 21] days; p = 0.011), and peak AST, ALT, and INR values were lower (p = 0.039, p = 0.021, and p = 0.027, respectively). The rate of any postoperative complications did not differ significantly (p = 0.439). In-hospital mortality was 19.0% in the recipient PV group, 36.4% in the prosthesis group, and 0% in the modified GSV group (p = 0.053). In this retrospective and temporally heterogeneous cohort, modified allogeneic GSV was technically feasible and demonstrated encouraging early neo-MHV conduit patency. Because conduit allocation was non-random, the groups were small and noncontemporaneous, and important baseline and procedural differences were present, the observed associations cannot be attributed to conduit materi-al and do not establish superiority. Further prospective evaluation is warranted.
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Article Type: Original Article
ELECTRON J GEN MED, Volume 23, Issue 5, October 2026, Article No: em752
https://doi.org/10.29333/ejgm/19441
Publication date: 27 Sep 2026
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