Human acellular dermal matrix for middle hepatic vein reconstruction in living donor liver transplantation: a prospective feasibility and safety study.

BACKGROUND

During living donor liver transplantation (LDLT), middle hepatic vein (MHV) reconstruction requires a conduit that preserves early venous outflow while avoiding late device-related complications typical of synthetic grafts. We evaluated human acellular dermal matrix (ADM) as an off-the-shelf biological conduit.

METHODS

In a prospective single-center cohort (2022-2025), adults undergoing LDLT with MHV reconstruction using ADM (n = 40) were followed. Outcomes were benchmarked against historical controls using Hemashield (n = 40) or polytetrafluoroethylene (PTFE; n = 20). Primary endpoints were early-phase patency (≤6 months) and major structural complications. Two blinded radiologists independently reviewed serial Doppler ultrasonography and contrast-enhanced computed tomography with consensus adjudication. Patency was estimated by Kaplan-Meier and compared with the log-rank test.

RESULTS

ADM achieved excellent early patency [95.0% (83.5-98.6) at 3 months; 85.0% (70.9-92.9) at 6 months]. At 18 months, patency was 62.5% for ADM versus 50.0% (PTFE) and 47.5% (Hemashield) (log-rank P = 0.785). No ADM graft required re-intervention, and no graft infection or duodenal invasion occurred (0/40 vs 2/60 [3.3%] in synthetic cohorts). Baseline characteristics were comparable. Case review showed that several ADM occlusions were associated with large bilomas, where secondary infection rather than intrinsic graft failure likely triggered thrombosis.

CONCLUSIONS

ADM is a feasible and safe biological conduit for MHV reconstruction, delivering robust patency throughout the critical period of graft regeneration while avoiding catastrophic complications observed with synthetic materials. These hypothesis-generating results support a randomized trial and introduce the concept of ADM as a temporary biological scaffold. Given its excellent early patency and safety profile, ADM should be considered a valuable addition to the surgical armamentarium with potential to redefine success in venous reconstruction.