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Background Portal hyperperfusion as a cause of small for size syndrome (SFSS) after living donor liver transplantation (LDLT) remains controversial. Portal venous pressure (PVP) is often measured indirectly and may be confounded by central venous pressure (CVP). Methods In 42 adult cirrhotics undergoing elective LDLT, PVP was measured by direct canulation of portal vein and porto systemic gradient (PSG) was obtained after subtracting CVP from PVP. None underwent portal inflow modulation. SFSS was looked in 27 patients after excluding 15 with technical complications. Results Clinical features of SFSS found in 6 patients, 5 with graft recipient weight ratio (GRWR) > 0.8% and PVP < 20 mm of Hg. One with GRWR < 0.8% could truly be labeled as SFSS. Incidence of SFSS was not higher in patients with elevated PVP > 20 mm of Hg (14.3% vs 0%, P = 0.259) or PSG > 13 mm of Hg (33.3% vs 0%, P = 0.111). Intensive care unit (ICU) stay was longer in patients with elevated PVP (14.55 vs 9.13 days, P = 0.007) and PSG (16.8 vs 9.72 days, P = 0.009). There was no difference in graft functions, post-operative complications and mortality in first month post-LDLT. Conclusion Elevated PVP or PSG increased morbidity but neither predicted SFSS nor affected survival. [ABSTRACT FROM AUTHOR]

Background: Although minimally invasive right donor hepatectomy (RDH) has been reported, this innovation is yet to be widely accepted by transplant community. Bleeding during transection, division of right hepatic duct (RHD), suturing of donor duct as well as retrieval with minimal warm ischemia are the primary concerns of most donor surgeons. We describe our simplified technique of robotic RDH evolved over 144 cases. Patients and Methods: Right lobe mobilization is performed in a clockwise manner from right triangular ligament over inferior vena cavae up to hepatocaval ligament. Transection is initiated using a combination of bipolar diathermy and monopolar shears controlled by console surgeon working in tandem with lap CUSA operated by assistant surgeon. With the guidance of indocyanine green cholangiography, RHD is divided with robotic endowrist scissors (Potts), and remnant duct is sutured with 6-0 PDS. Final posterior liver transection is completed caudocranial without hanging manoeuvre. Right lobe with intact vascular pedicle is placed in a bag, vascular structures then divided, and retrieved through Pfannenstiel incision. Conclusion: Our technique may be easy to adapt with the available robotic instruments. Further innovation of robotic platform with liver friendly devices could make robotic RDH the standard of care in future. [ABSTRACT FROM AUTHOR]

Small bowel transplants are performed all over the world with acceptable success rates. Although there are isolated reports of small bowel transplants from India, a robust intestinal transplant programme similar to western countries is lacking. Our aim is to share our experience to build up on the evolving field of small bowel transplants in India. Deceased donor small bowel transplant was performed for three patients with intestinal failure, two for short gut syndrome following surgery and one for visceral myopathy. All were on preoperative total parenteral nutrition for varying periods of time (6 to 13 months). There were multiple episodes of line sepsis in all patients. Post-transplant, all received induction immunosuppression with anti-thymocyte globulin (first two patients) or alemtuzumab (3rd patient). All had systemic venous drainage and stoma. Protocol weekly intestinal biopsies were done in all patients. All died in hospital at 24, 12 and 28 days following surgery. Biopsy-proven rejection was observed in only patient who had received ABO-compatible non-identical graft (O to A). This patient subsequently developed vascular thrombosis necessitating explant of the graft. Sepsis due to multidrug resistant bacteria was the reason for mortality in the remaining two patients. Despite the absence of technical complications, successful small bowel transplant seems to be an elusive entity for the Indian transplant community. [ABSTRACT FROM AUTHOR]

To compare the safety and efficacy of once-daily tacrolimus (ODT) versus twice-daily tacrolimus (BDT) in adult live donor liver transplantation (LDLT). In this open-labelled randomized trial, 174 adult patients undergoing LDLT were randomized into ODT or BDT, combined with basiliximab induction and mycophenolate mofetil (steroid-free regimen). Tacrolimus was started at a total dose of 1 mg and the trough level was aimed at 3–7 ng/ml. The primary endpoint was eGFR at 1,3- and 6 months post-transplant, using CKD- EPI equation. Secondary endpoints included biopsy-proven acute rejection (BPAR), metabolic complications, post-operative bilio-vascular complications and patient survival. There was no statistically significant difference in eGFR between the two groups at 6 months (ODT –96 ± 19, BDT –91 ± 21, p value-0.164). BPAR was comparable (18/84 in ODT, 19/88 in BDT, p value-0.981). For a similar dosage of tacrolimus, the median trough tacrolimus levels attained were significantly lower for ODT than BDT during the first-month post-transplant (p value-0.001). Metabolic complications due to immunosuppression, post-operative bilio-vascular complications and patient survival was similar between the two groups at 6 months. Once-daily tacrolimus has similar renal safety and efficacy as twice-daily tacrolimus when used in combination with basiliximab induction and mycophenolate in adult LDLT. [ABSTRACT FROM AUTHOR]

Background: Biliary complications continue to be the "Achilles heel" of living-donor liver transplantation (LDLT). The use of biliary stents in LDLT to reduce biliary complications is a controversial issue. We performed a randomized trial to study the impact of intraductal biliary stents on postoperative biliary complications after LDLT.Study Design: Of the 94 LDLTs that were performed during a period of 16 months, ABO-incompatible transplants, left lobe grafts, 3 or more bile ducts on the graft, and those requiring bilioenteric drainage were excluded. Eligible patients were randomized to either a study arm (intraductal stent, n = 31) or a control arm (no stent, n = 33) by block randomization. Stratification was done, based on the number of ducts on the graft requiring anastomosis, into single (n = 20) or 2 ducts (n = 44). Ureteric stents of 3F to 5F placed across the biliary anastomosis and exiting into the duodenum for later endoscopic removal at 3 months were used. The primary end point was postoperative bile leak.Results: Bile leak occurred in 15 of 64 (23.4%), the incidence was higher in the stented group compared with the control group (35.5% vs 12.1%; p = 0.03). Multiplicity of bile ducts and stenting were identified as risk factors for bile leak on multivariate analysis (p = 0.031 and p = 0.032). During a median follow-up of 2 years, biliary stricture developed in 9 patients (14.1%). Postoperative bile leak is a significant risk factor for the development of biliary stricture (p = 0.003).Conclusions: Intraductal transanastomotic biliary stenting and multiplicity of graft ducts were identified as independent risk factors for the development of postoperative biliary complications. [ABSTRACT FROM AUTHOR]

The aim of this study was to prospectively evaluate stereotactic body radiotherapy (SBRT) with robotic radiosurgery in hepatocellular carcinoma patients with macrovascular invasion (HCC-PVT). Patients with inoperable HCC-PVT, good performance score (PS0-1) and preserved liver function [up to Child-Pugh (CP) B7] were accrued after ethical and scientific committee approval [Clinical trial registry-India (CTRI): 2022/01/050234] for treatment on robotic radiosurgery (M6) and planned with Multiplan (iDMS V2.0). Triple-phase contrast computed tomography (CT) scan was performed for contouring, and gross tumour volume (GTV) included contrast-enhancing mass within main portal vein and adjacent parenchymal disease. Dose prescription was as per risk stratification protocol (22–50 Gy in 5 fractions) while achieving the constraints of mean liver dose <15 Gy, 800 cc liver <8 Gy and the duodenum max of <24 Gy). Response assessment was done at 2 months' follow-up for recanalization. Patient- and treatment-related factors were evaluated for influence in survival function. Between Jan 2017 and May 2022, 318 consecutive HCC with PVT patients were screened and 219 patients were accrued [male 92%, CP score: 5–7 90%, mean age: 63 years (38–85 yrs), Cancer of the Liver Italian Program <3: 84 (40%), 3–6117 (56%), infective aetiology 9.5%, performance status (PS): 0–37%; 1–56%]. Among 209 consecutive patients accrued for SBRT treatment (10 patients were excluded after accrual due to ascites and decompensation), 139 were evaluable for response assessment (>2 mo follow-up). At mean follow-up of 12.21 months (standard deviation: 10.66), 88 (63%) patients expired and 51 (36%) were alive. Eighty-two (59%) patients had recanalization of PVT (response), 57 (41%) patients did not recanalize and 28 (17%) had progressive/metastatic disease prior to response evaluation (<2 months). Mean overall survival (OS) in responders and non-responders were 18.4 [standard error (SE): 2.52] and 9.34 month (SE 0.81), respectively (P < 0.001). Mean survival in patients with PS0, PS1 and PS2 were 17, 11.7 and 9.7 months (P = 0.019), respectively. OS in partial recanalization, bland thrombus and complete recanalization was 12.4, 14.1 and 30.3 months, respectively (P -0.002). Adjuvant sorafenib, Barcelona Clinic Liver Classification stage, gender, age and RT dose did not influence response to treatment. Recanalization rate was higher in good PS patients (P -0.019). OS in patients with response to treatment, in those with no response to treatment, in those who are fit but not accrued and in those who are not suitable were 18.4, 9.34, 5.9 and 2.6 months, respectively (P -<0.001). Thirty-six of 139 patients (24%) had radiation-induced liver disease (RILD) [10 (7.2%) had classic RILD & 26 (19%) had non-classic RILD]. Derangement in CP score (CP score change) by more than 2 was seen in 30 (24%) within 2-month period after robotic radiosurgery. Eighteen (13%) had unplanned admissions, two patients required embolization due to fiducial-related bleeding and 20 (14%) had ascites, of which 9 (6%) patients required abdominocentesis. PVT response or recanalization after SBRT is a statistically significant prognostic factor for survival function in HCC-PVT. [ABSTRACT FROM AUTHOR]

Robotic right live donor hepatectomy (r‐LDRH) has been reported with reduced morbidity compared to open donor right hepatectomy (o‐LDRH) in few recent series. Nevertheless, its routine use is debated. We present a large series comparing pure r‐LDRH with o‐LDRH. Consecutive r‐LDRH performed from June 2018 to June 2020 (n = 102) were compared with consecutive donors undergoing o‐LDRH (n = 152) from February 2016 to February 2018, a period when r‐LDRH was not available at this center. Propensity score matched (PSM) analysis of 89 case‐control pairs was additionally performed. Primary endpoints were length of high dependency unit (HDU) and hospital stay and Clavien‐Dindo graded complications among donors. Although r‐LDRH took longer to perform (540 vs. 462 min, P <.001), the postoperative peak transaminases levels (P <.001), the length of HDU (3 vs. 4 days, P <.001), and hospital stay (8 vs. 9 days, P <.001) were lower in in donors undergoing r‐LDRH. Clavien‐Dindo graded complications were similar (16.67% in r‐LDRH and 13.16% in o‐LDRH). The rates of early allograft dysfunction (1.6% vs. 3.3%), bile leak (14.7% vs. 10.7%), and 1‐year mortality (13.7% vs. 11.8%) were comparable between r‐LDRH and o‐LDRH recipients. PSM analysis yielded similar results between the groups. These data support the safety and feasibility of r‐LDRH in select donors. [ABSTRACT FROM AUTHOR]

Auxiliary partial orthotopic liver transplantation (APOLT) entails the removal of part of the native liver and replacement with the corresponding part of donor liver. APOLT is usually performed for acute liver failure and metabolic liver disease. However, many technical concerns limit its acceptance globally. In this study, we describe our experience of 6 APOLT performed for acute liver failure. Out of the 68 liver transplants performed in our center for acute liver failure, six were APOLT. APOLT was performed in the setting of hyperacute liver failure with no other organ failure. The recovery of the native liver was assessed using hepatobiliary scintigraphy every six months. Immunosuppressant withdrawal was attempted once 50% recovery of the native liver was attained in the scan. All donors were first-degree relatives. Etiology was hepatitis A in 4 patients, yellow phosphorous poisoning in 1, and cryptogenic fulminant hepatic failure in the remaining 1 patient. Five of them were blood group identical and one was ABO incompatible (AB to A). Post-operatively, three patients died, two due to massive cerebral edema, and one due to sepsis. All the survivors at a follow-up period of 2 years are off immunosuppressants and are doing well. Auxiliary liver transplant in acute liver failure has a poor success rate. However, the technique can be considered in a very selected group of patients with hepatitis A-related hyperacute liver failure. [ABSTRACT FROM AUTHOR]

Adult-to-adult living donor liver transplant (LDLT) frequently depend on using the right-lobes of the donor for obtaining adequate graft-to-recipient weight ratio (GRWR) of over 0.8% in the recipient. However, left-lobes remain an important option in adults, since the morbidity in the donor is considerably less with left donor hepatectomy when compared with right side liver resection. Further benefits of left-lobes in LDLT include more predictable anatomy of the left hepatic duct and left portal vein, which are usually long and single resulting in easier anastomosis in the recipient. Likewise, left-lobe grafts are easier to implant with an excellent venous outflow through the combined orifice of left and middle hepatic vein, as opposed to the complex hepatic vein reconstruction required in right-lobe grafts. However, left hepatic artery is often multiple unlike the right hepatic artery. The holy grail of left-lobe transplants is avoidance of small for size syndrome (SFSS) in the recipients. The strategies for overcoming SFSS currently depend on circumventing portal hyperperfusion in the graft. Measurement of portal pressure and modulating it if high, by splenic artery ligation, splenectomy, or hemiportocaval shunts are proving successful in avoiding SFSS. The future aim in adult LDLT should be to use the left-lobe as much as possible for the benefit of the donor at the same time avoiding SFSS even at very low GRWR for the benefit of the recipient. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Corticosteroids are an integral part of immunosuppression following solid organ transplantation, despite their metabolic complications. We conducted a randomized trial to evaluate the efficacy of steroid-free immunosuppression following live donor liver transplantation (LDLT). We randomized 104 patients stratified based on pre-transplant diabetic status to either a steroid-free arm (SF-arm) (Basiliximab + Tacrolimus and Azathioprine,n = 52) or Steroid arm (S-Arm) (Steroid + Tacrolimus + Azathioprine,n = 52). The primary endpoint was the occurrence of metabolic complications (new-onset diabetes after transplant (NODAT), new-onset systemic hypertension after transplant (NOSHT), post-transplant dyslipidemia) within 6 months after transplant. Secondary endpoints included biopsy-proven acute rejection (BPAR) within six months, patient and graft survival at 6 months. The incidence NODAT was significantly higher in S-arm at 3 months (64.5%vs. 28.1%,p-0.004) and 6 months (51.6% vs. 15.6%,p-0.006). Likewise, the incidence of NOSHT (27.8% vs. 4.8%,p-0.01) and hypertriglyceridemia (26.7% vs. 8%,p-0.03) at six months was significantly higher in S-arm. However, there were no differences in BPAR (19.2% vs. 21.2%, p-0.81), time to first rejection (58 vs. 53 days, p-0.78), patient and graft survival (610 vs. 554 days,p- 0.22). Following LDLT, basiliximab induction with tacrolimus and azathioprine maintenance resulted in significantly lower metabolic complications compared to the triple-drug regimen of steroid, tacrolimus, and azathioprine. [ABSTRACT FROM AUTHOR]

Acute liver failure (ALF) is the leading cause for emergency liver transplantation (LT) all over the world. We looked at the profile of cases who required LT for ALF from a single centre to identify the possible predictors of poor outcomes. During the 10-year period starting from 2007, 320 cases of ALF were treated at our institution, of which 70 (median age 24 years, Male:Female 1:2) underwent LT. Retrospective analyses of these 70 patients were performed. Etiology was identifiable in 73% (n = 51) of cases (yellow phosphorous [YP] poisoning [n = 16], Hepatitis A virus [HAV] [n = 15], Hepatitis B virus [HBV] [n = 5], Hepatitis E virus [HEV] [n = 1], anti-tubercular therapy [ATT] induced [n = 6], acute Wilson's [n = 3], and autoimmune [n = 5]]. Upon meeting King's College Hospital criteria, 69 had live donor LT (61 right lobe grafts, three left lobe grafts, five left lateral segment grafts) and one had deceased donor LT. Among these, there were five auxiliary partial orthotopic grafts and four ABO-incompatible transplants. Overall, 90-day mortality was 35.7% (n = 25), predominantly due to sepsis. Significant risk factors for mortality on multivariate analysis included indeterminate etiology, pre-op renal dysfunction, and Grade IV hepatic encephalopathy (HE). Cumulative 10-year survival of the remaining survivors was 95.6% (n = 45). LT for ALF carries high perioperative mortality (35.7%) in those presenting with indeterminate etiology, pre-op renal dysfunction, and Grade IV HE. Nevertheless, if they survive the perioperative period, long-term survival is excellent. [ABSTRACT FROM AUTHOR]

Introduction: In live donor liver transplantation (LDLT), bile duct division is a critical step in donor hepatectomy. Biliary complications hence are a feared sequelae even among donors. Long term data on biliary complications in donors from India are sparse.Methods: Prospective evaluation of 452 live donors over 10 years was performed to ascertain the incidence & risk factors of clinically significant biliary complications.Results: Of the 452 donor hepatectomies (M: F = 114:338, median age = 38), 66.2% (299) were extended right lobe grafts, 24.1% (109) modified right lobe and 9.7% (44) were left lobe grafts. Portal vein anatomy was Type-I in 85% (386), Type-II in 7.5% (34) and Type-III in 7.1% (32). Following donor hepatectomy, a single bile duct opening occurred only in 46.5% (210) of the grafts. Of the remaining 53.5% grafts, 2 ductal openings were noted in 217 (48%) and three ductal openings in 25 (5.5%). Incidence of multiple openings in the duct were more commonly noted in Type II (70.6%) and III (75%) portal vein anatomy than in grafts with Type I (50.4%) portal anatomy (P = 0.001) Bile leak was noted in 15 (3.3%) donors which included one broncho-biliary fistula and bilio-pleural fistula. Analysis revealed no association between post-operative biliary complications and type of graft, portal vein anatomy or biliary anatomy. There was a single mortality in this series secondary to biliary sepsis. On long term follow, there were no biliary strictures in any of the patients.Conclusions: Biliary complications although rare (3.3%), present significant peri-operative morbidity to the donors. [ABSTRACT FROM AUTHOR]

Background: Recipient outcomes in adult living donor liver transplantation depend on various characteristics in both recipient and donor. We aimed to derive a score based upon preoperative characteristics in donor and recipient that could predict the recipient mortality in adult living donor liver transplantation. Material/Methods: Retrospective data of 100 living donor liver transplantation recipients and their respective donors were analyzed for preoperative factors that correlated with recipient mortality. Statistically significant factors were weighted appropriately to derive a regression equation to obtain a donor-to-recipient match (DORMAT) score. This score was applied to 71 patients prospectively and their outcome was analyzed. Results: Donor-recipient match (DORMAT) score, derived using regression analysis of the significant variables was [0.002 (Recipient age) + 0.013 (Recipient BMI) + 0.055 (SBP) + 0.344 (HRS) + 0.022 (Pre-op culture positivity) + 0.01 (Donor age) - 0.639]×100. DORMAT score, when validated to a prospective cohort of 71 adult-to-adult LDLT patients, had a C-statistic (area under ROC curve) of 0.712. The mortality rate was seen to increase with increasing DORMAT score. Conclusions: DORMAT score is a useful clinical decision-making tool to predict recipient mortality in adult living donor liver transplantation. [ABSTRACT FROM AUTHOR]

Background In living donor liver transplantation (LDLT), graft-to-recipient weight ratio (GRWR) > 0.8% is perceived as the critical graft size. This lower limit of GRWR (0.8%) has been challenged over the last decade owing to the surgical refinements, especially related to inflow and outflow modulation techniques. Our aim was to compare the recipient outcome in small-for-size (GRWR < 0.8) versus normal-sized grafts (GRWR > 0.8) and to determine the risk factors for mortality when small-for-size grafts (SFSG) were used. Methods Data of 200 transplant recipients and their donors were analyzed over a period of two years. Routine practice of harvesting middle hepatic vein (MHV) or reconstructing anterior sectoral veins into neo-MHV was followed during LDLT. Outcomes were compared in terms of mortality, hospital stay, ICU stay, and occurrence of various complications such as functional small-for-size syndrome (F-SFSS), hepatic artery thrombosis (HAT), early allograft dysfunction (EAD), portal vein thrombosis (PVT), and postoperative sepsis. A multivariate analysis was also done to determine the risk factors for mortality in both the groups. Results Recipient and donor characteristics, intraoperative variables, and demographical data were comparable in both the groups (GRWR < 0.8 and GRWR ≥ 0.8). Postoperative 90-day mortality (15.5% vs. 22.85%), mean ICU stay (10 vs. 10.32 days), and mean hospital stay (21.4 vs. 20.76 days) were statistically similar in the groups. There was no difference in postoperative outcomes such as occurrence of SFSS, HAT, PVT, EAD, or sepsis between the groups. Thrombosis of MHV/reconstructed MHV was a risk factor for mortality in grafts with GRWR < 0.8 but not in those with GRWR > 0.8. Conclusion Graft survival after LDLT using a small-for-size right lobe graft (GRWR < 0.8%) is as good as with normal grafts. However, patency of anterior sectoral outflow by MHV or reconstructed MHV is crucial to maintain graft function when SFSG are used. [ABSTRACT FROM AUTHOR]

Background: Once daily (OD) tacrolimus, recently launched for post liver transplant immunosuppression might offer better compliance and efficacy compared to standard twice daily (BID) tacrolimus. Data from India, however is sparse. Aim: The aim of our study was to compare the efficacy and adverse effects of OD versus BID tacrolimus formulation in liver transplant recipients. Methods: This was a retrospective, observational, comparative study of 115 patients who were on tacrolimus based regimens (tacrolimus BID: 92; M: F-75:17 and tacrolimus OD: 23; M: F-22:1). Total daily dose and trough levels of tacrolimus were recorded at 1, 3, 6, 12 and 24 months after transplantation. Results: Median age in tacrolimus BID and OD groups were 45 years (6-64 years) and 50 years (1-70 years), respectively. The median tacrolimus dose was significantly lower in the tacrolimus OD arm at all the time points studied. Tacrolimus trough levels were significantly lower in the tacrolimus OD group at 3 and 6 months. The biopsy proven rejection rate was 15.2% and 0% in the tacrolimus BID and OD groups, respectively. Two year patient and graft survival rate was 89.4% in the tacrolimus BID and 87.5% in the tacrolimus OD group. The incidence of new onset diabetes, renal dysfunction, dyslipidemia, neurotoxicity, hyperkalemia and weight gain were comparable between the two arms. Conclusion: Tacrolimus OD has a lower rejection rate compared to its BID formulation. However, this does not translate into better patient or graft survival. Both the formulations appear to be comparable with respect to the adverse effect and tolerability profile. [ABSTRACT FROM AUTHOR]

Highlights from the article: Robotic Donor Hepatectomy: Guts to Change a Winning Team? Complete/pure robotic donor hepatectomies were performed in 13 patients (with pfannensteil incision for graft retrieval) and 10 patients received robotic assisted donor hepatectomies (with sub-costal incision for graft retrieval). Currently, apart from the scar position and scar length, robotic donor Hepatectomy does not show any difference in comparison with open donor Hepatectomy with respect to ICU or hospital stay.

Highlights from the article: Randomized Trial of Polytetrafluoroethylene Graft VS. Native Recipient Portal Vein Graft for Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation (LDLT) The reconstruction of the MHV can be with the portal vein (PV) from the recipient explanted liver, allogenic veins or synthetic grafts. Between PTFE and PV, early graft dysfunction (0 vs 3.2%), small for size syndrome (2.4% vs. 2.6%), the infection rate (34% vs 33%), the hospital stay (20.6 vs 19.6 days), ICU stay (9.24 vs. 9.4 days) and mortality (4.9% vs 15.4%) was comparable.