Emergency Deceased Donor Liver Transplantation Using a PTFE Graft for Complex Arterial Reconstruction: A Technical Note.

Hepatic artery reconstruction is technically challenging and a critical step in liver transplantation, particularly in patients with anatomical variations or compromised arterial flow. The present technical note describes an emergency liver transplantation for hepatitis B virus-induced acute liver failure, where standard vascular reconstruction options, including autologous grafts, were exhausted. Given the recipient's small-caliber hepatic arteries, vasospasm, and hemodynamic instability, a 6 × 40 mm polytetrafluoroethylene (PTFE) vascular graft was utilized to restore arterial flow. The reconstruction involved anastomosis between the infrarenal aorta and the donor's celiac trunk at splenic artery bifurcation, ensuring adequate graft perfusion with adjusted arterial and portal flow rates. To prevent passage between the small bowel which could increase the risk of intestinal obstruction, the PTFE graft was positioned retroperitoneally. This technical note highlights the feasibility of PTFE grafts as a salvage solution for arterial reconstruction in emergent liver transplantation when standard options are unavailable.