The fate of non-absorbable suture in growing vascular anastomoses in liver transplantation

Background/Aims: Anastomotic stricture of the portal vein is an uncommon complication of orthotopic liver transplantation for which the etiology is unclear. In the present study, we evaluated the fate of continuous anastomosis by non-absorbable suture material in growing vessels after orthotopic liver transplantation in pigs. Materials and Methods: A pig which had undergone orthotopic liver transplantation 54 months earlier was autopsied and inspected for vascular growth and their anastomotic patency. Results: The pig weighed 270 kg (1,080%) at 54 months after orthotopic liver transplantation. The liver was normal in, appearance and weighed 4,100 g (770%). All the vessels anastomosed were patent. However, luminal stenosis of the portal vein was identified at the anastomosis site, where intraluminal protrusion of the anastomosis was prominent. The inability of the suture material to grow longer than its full length along with the growth of the portal vein was suggested to be the main cause of the stenosis. Conclusion: We conclude that the use of non-absorbable sutures could cause late vascular anastomotic stricture in pediatric orthotopic liver transplantation.