Great saphenous vein harvesting for venous outflow reconstruction in living donor liver transplantation – A minimally invasive refinement of the conventional procedure

BackgroundWith the popularization of living donor liver transplantation (LDLT), it has been discovered that adequate venous outflow from the transplanted liver is crucial for proper graft function. Recently, the harvesting of the LDLT recipient's autologous great saphenous vein (GSV) has been increasingly adopted as a solution to the shortage of cadaveric vascular grafts.Minimally invasive GSV harvesting for coronary artery bypass grafting was shown to improve the cosmetic result and reduce leg wound pain and other complications. For immunosuppressed patients such as LDLT recipients, these benefits could be especially valuable.Materials and methodsFrom April to August 2012, eleven LDLT recipients underwent either minimally invasive or short-incision harvesting of GSV. The patient profiles, operative and postoperative information regarding operation time, estimated blood loss, harvested GSV graft length, serum tacrolimus (FK506) levels and postoperative complications were recorded prospectively.ResultsThe only wound complication was a subcutaneous hematoma, in our fourth patient. The mean operation time and the mean estimated blood loss were 33.9 min and 7.3 ml respectively. The mean incision length divided by the mean vein graft length was 31.6%. Two patients had poorly controlled diabetes mellitus. The mean serum FK506 level during the first postoperative week was 6.4 ng/ml (therapeutic range 5–10 ng/ml according to our protocol). No patient had surgical site infection in this series.ConclusionsGSV harvesting from LDLT recipients for hepatic venous outflow reconstruction is feasible without the need for expensive endoscopic systems, and an adequate length of vein can be obtained through a single 3 cm incision.