• Mettu Srinivas Reddy, Akshadhar J Koneti, Abhideep Chaudhary, Ashwin Rammohan, Raghavendra Babu Yelakanti, Shweta Mallick, Rajanikanth Patcha, Vipin Pal Singh, Satish Kumar Krishnan, Niteen Kumar, Prasanna V Gopal, Mohamed Rela, and Surendran Sudhindran.
• Department of Liver Transplantation & HPB Surgery, Gleneagles Health City, Chennai, India.
• Ann. Surg. 2024 Dec 11.

ObjectiveTo 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 DataOptimum 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.MethodsAdult 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.ResultsFive 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.ConclusionsSOT has better early neoMHV patency than DOT and may be associated with better early survival.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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