Objective: To compare early patency and outcomes of single outflow (SOT) and double outflow (DOT) reconstruction in right lobe living donor liver transplantation (RtLDLT) in a multicenter open-labelled randomized controlled trial.
Summary background data: Optimum graft venous outflow is a key factor in determining outcomes of RtLDLT. There is no data directly comparing SOT and DOT technique of graft outflow reconstruction.
Methods: Adult patients undergoing RtLDLT needing anterior sector vein (ASV) reconstruction were enrolled. Prosthetic graft was used to create a neo-middle hepatic vein (neoMHV). Web-based permuted block randomization was used to allocate patients to SOT or DOT (1:1) prior to graft implantation. Primary endpoint was neoMHV patency upto 6 weeks. Secondary endpoints were post-operative morbidity and survival. Intention-to-treat and as-treated analyses are reported.
Results: Five centers randomized 219 patients to SOT (n=110) or DOT (n=109). Both groups were similar in baseline characteristics. SOT had better neoMHV patency at 2 weeks (92.5% vs. 82.9%, P=0.032), 4 weeks (84% vs. 69%, P=0.011) but not at 6 weeks (69.5% vs. 59.2%,P=0.124). Cox- proportional hazards analysis revealed DOT (HR- 1.56 (95%ci=1.02,2.4); P=0.041) and use of Dacron graft (HR-2.83(95% ci=1.16,6.94), P=0.023) as independent risk factors for neoMHV thrombosis. SOT was associated with better in-hospital survival (97.3% vs. 90.8%; P=0.044) but similar one-year survival (89% vs. 85%, P=0.340). SOT was associated with improved survival in patients who developed early allograft dysfunction or needed re-operation.
Conclusions: SOT has better early neoMHV patency than DOT and may be associated with better early survival.
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