Introduction : Most of the grafts used as interposition conduits for the middle hepatic vein (MHV) in living donor liver transplantation (LDLT) have been allografts and autografts. Recently, peritoneum has been used for vessel substitutes during surgery. Thus, we performed animal lab tests to assess the feasibility of interposition vessel graft substitutes for MHV.

Methods : The inferior vena cava was replaced in three dogs and three pigs with autologous peritoneal vessel graft. After 28 days, patency rate, outer and inner diameter, intimal thickness, histology, and immunohistochemistry were evaluated according to interposition grafts.

Results : The vessel grafts made of the peritoneum were all animals at postoperative week 4. The outer diameter of the anastomotic site at four weeks was 8.41±0.37 and 7.41±0.86 mm in before surgery and after four weeks, respectively. The inner diameter of the interposition graft at four weeks was 7.90±0.23 and 6.33±0.68 in before surgery and after four weeks, respectively. In histologic findings, the intima of the anastomotic site was thickest in all animals. The proliferation of smooth muscle cells was most severe in the anti-alpha-actin antibody test at the anastomosis site. On the inner side of the peritoneum, endothelial cell migration was found over whole segments.

Conclusions : Our data implicate that the use of peritoneum as interposition vessel grafts are feasible for MHV reconstruction in LDLT.