Duodenal fistula secondary to erosion by an expanded polytetrafluoroethylene graft in a living donor liver transplant: a case report and review of the literature.

Abstract

Living donor liver transplantation (LDLT) has become an established treatment for patients with decompensated chronic liver diseases of various etiologies, acute liver failure, and liver tumors (primary and secondary). A right lobe graft without the middle hepatic vein is often preferred to achieve adequate graft weight, and an expanded polytetrafluoroethylene (ePTFE) graft is used to reconstruct the anterior sector outflow and optimize allograft function. Generally, this approach is safe and effective until optimal regeneration of the posterior sector occurs. Thrombosis of the ePTFE graft is usually inconsequential for the recipient. Other rare complications of the ePTFE graft include migration into the common bile duct, stomach, duodenum, or jejunum. We report a case of ePTFE graft migration into the duodenum, resulting in a duodenal fistula, which was resolved after endoscopic removal and clipping, in a 44-year-old patient with chronic liver disease secondary to hepatitis B and hepatitis D co-infection. The uniqueness of this case lies in the rarity of this complication and its successful endoscopic management. At 6 months of follow-up, the patient is doing well, with normal allograft function and complete healing of the duodenal fistula. This case highlights the potential complication of an inert ePTFE graft in LDLT, which requires clinical suspicion, evaluation, and can be managed endoscopically.