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The following is a summary of “Multicenter Randomised Controlled Trial of Single versus Double Venous Outflow Reconstruction in Right lobe Living Donor Liver Transplantation- Venous Outflow in Liver Transplantation (VOLT) Trial,” published in the December 2024 issue of Surgery by Reddy et al.
Graft venous outflow is key in determining outcomes in right-lobe living donor liver transplantation (RtLDLT). Still, there is no direct comparison between the single outflow technique (SOT) and the double outflow technique (DOT).
Researchers conducted a retrospective study comparing early patency and outcomes of single vs. double venous outflow reconstruction in RtLDLT.
They randomly assigned adult patients undergoing RtLDLT requiring anterior sector vein (ASV) reconstruction to either single outflow (SOT, n=110) or double outflow (DOT, n=109) groups using web-based permuted block randomization. A prosthetic graft created a neo-middle hepatic vein (neoMHV). The primary endpoint was neoMHV patency for up to 6 weeks. Secondary endpoints included postoperative morbidity and survival.
The results showed that SOT had better neoMHV patency at 2 weeks (92.5% vs. 82.9%, P=0.032) and 4 weeks (84% vs. 69%, P=0.011) but not at 6 weeks (69.5% vs. 59.2%, P=0.124). Cox proportional hazards analysis revealed double outflow (HR=1.56 [95% CI=1.02, 2.4]; P=0.041) and use of Dacron graft (HR=2.83 [95% CI=1.16, 6.94]; P=0.023) as independent risk factors for neoMHV thrombosis. The SOT was associated with better in-hospital survival (97.3% vs. 90.8%; P=0.044), but similar 1-year survival (89% vs. 85%, P=0.340), SOT also improved survival in patients who developed early allograft dysfunction or required re-operation.
They concluded that single outflow reconstruction provided better early neoMHV patency and may improve early survival in people undergoing RtLDLT.
