Abstract Background In adult right lobe living donor liver transplantation (LDLT), venous drainage of the anterior sector is usually reconstructed on the bench to form a neo-middle hepatic vein (MHV). Reconstruction of the MHV for drainage of the anterior sector is crucial for optimal graft function. The conduits used for reconstruction include cryopreserved allografts, synthetic grafts, or the recipient portal vein. However, the ideal choice remains a matter of debate. This study compares the efficacy of the native recipient portal vein (RPV) with PTFE grafts for reconstruction of the neo-MHV. Methods Patients in this equivalence-controlled, parallel-group trial were randomized to either RPV (62 patients) or PTFE (60 patients) for use in the reconstruction of the neo-MHV. Primary endpoint was neo-MHV patency at 14 days and 90 days. Secondary outcomes included 90-day mortality and post-transplant parameters as scored by predefined scoring systems. Results There was no statistically significant difference in the incidence of neo-MHV thrombosis at 14 days (RPV 6.5 per cent versus PTFE 10 per cent; P = 0.701) and 90 days (RPV 14.5 per cent versus PTFE 18.3 per cent; P = 0.745) between the two groups. Irrespective of the type of graft used for reconstruction, 90-day all-cause and sepsis-specific mortality was significantly higher among patients who developed neo-MHV thrombosis. Neo-MHV thrombosis and sepsis were identified as risk factors for mortality on Cox proportional hazards analysis. No harms or unintended side effects were observed in either group. Conclusion In adult LDLT using modified right lobe graft, use of either PTFE or RPV for neo-MHV reconstruction resulted in similar early patency rates. Irrespective of the type of conduit used for reconstruction, neo-MHV thrombosis is a significant risk factor for mortality. Registration number CTRI/2018/11/016315 (www.ctri.nic.in).

中文翻译：

---

成人活体肝移植中肝中静脉重建：一项随机临床试验

摘要 背景在成人右叶活体肝移植（LDLT）中，通常在工作台上重建前段静脉引流，形成新肝中静脉（MHV）。重建 MHV 以进行前部引流对于实现最佳移植功能至关重要。用于重建的导管包括冷冻保存的同种异体移植物、合成移植物或受体门静脉。然而，理想的选择仍然存在争议。本研究比较了天然受体门静脉 (RPV) 与 PTFE 移植物重建 neo-MHV 的功效。 方法在这项等效对照平行组试验中，患者被随机分配至 RPV（62 名患者）或 PTFE（60 名患者），用于重建新 MHV。主要终点是 14 天和 90 天时的新 MHV 通畅情况。次要结局包括 90 天死亡率和由预定义评分系统评分的移植后参数。 结果14 天（RPV 6.5% 对比 PTFE 10%；P = 0.701）和 90 天（RPV 14.5% 对比 PTFE 18.3%；P = 0.745）时新 MHV 血栓形成率没有统计学显着差异两组之间。无论用于重建的移植物类型如何，发生新 MHV 血栓形成的患者的 90 天全因死亡率和败血症特异性死亡率均显着较高。根据 Cox 比例风险分析，新 MHV 血栓形成和脓毒症被确定为死亡的危险因素。两组均未观察到任何伤害或意外副作用。 结论在使用改良右叶移植物的成人 LDLT 中，使用 PTFE 或 RPV 进行新 MHV 重建导致了相似的早期通畅率。无论用于重建的导管类型如何，新 MHV 血栓形成都是死亡的重要危险因素。 注册号码CTRI/2018/11/016315 (www.ctri.nic.in)。