{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:51:46Z","timestamp":1781679106697,"version":"3.54.5"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3389\/frtra.2026.1799453","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:52:16Z","timestamp":1781675536000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Duodenal fistula secondary to erosion by an expanded polytetrafluoroethylene graft in a living donor liver transplant: a case report and review of the literature"],"prefix":"10.3389","volume":"5","author":[{"given":"Kausar","family":"Makki","sequence":"first","affiliation":[{"name":"Department of Liver Transplant and HPB Surgery, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini Kanta","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Liver Transplant and HPB Surgery, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Liver Transplant and HPB Surgery, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tathagata","family":"Karan","sequence":"additional","affiliation":[{"name":"Department of Liver Transplant and HPB Surgery, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Vij","sequence":"additional","affiliation":[{"name":"Department of Liver Transplant and HPB Surgery, Fortis Hospital","place":["Noida, Uttar Pradesh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1002\/lt.21213","article-title":"An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation","volume":"13","author":"Yi","year":"2007","journal-title":"Liver Transpl."},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.1016\/j.transproceed.2008.07.024","article-title":"Artificial vascular graft for inferior vena cava reconstruction in living donor liver transplantation: a case report","author":"Jeng","year":"2008"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3284","DOI":"10.12659\/msm.902636","article-title":"Assessing the safety of expanded polytetrafluoroethylene synthetic grafts in living donor liver transplantation: graft migration into hollow viscous organs\u2013diagnosis and treatment options","volume":"23","author":"Hsu","year":"2017","journal-title":"Med Sci Monit Int Med J Exp Clin Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/00007890-200207150-00010","article-title":"Modified right liver graft from a living donor to prevent congestion1","volume":"74","author":"Gyu Lee","year":"2002","journal-title":"Transplantation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1002\/lt.23456","article-title":"Usability of ringed polytetrafluoroethylene grafts for middle hepatic vein reconstruction during living donor liver transplantation","volume":"18","author":"Hwang","year":"2012","journal-title":"Liver Transpl."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1016\/j.surg.2021.01.011","article-title":"Venous outflow reconstruction using a polytetrafluoroethylene (PTFE) graft in right lobe living donor liver transplantation: a single center study","volume":"169","author":"Singhal","year":"2021","journal-title":"Surgery"},{"key":"B7","doi-asserted-by":"publisher","first-page":"502","DOI":"10.6002\/ect.2015.0355","article-title":"Duodenal penetration by the ringed expanded polytetrafluoroethylene graft for middle hepatic vein reconstruction during living-donor liver transplant: a case report","volume":"16","author":"Park","year":"2016","journal-title":"Exp Clin Transplant Off J Middle East Soc Organ Transplant"},{"key":"B8","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/tri.13807","article-title":"Complications of polytetrafluoroethylene graft use in middle hepatic vein reconstruction in living donor liver transplantation: a retrospective, single-centre, long-term, real-world experience","volume":"34","author":"Woo","year":"2021","journal-title":"Transpl Int."},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1016\/j.transproceed.2013.10.054","article-title":"Complications analysis of polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation","author":"Ha","year":""},{"key":"B10","doi-asserted-by":"publisher","first-page":"101471","DOI":"10.1016\/j.jceh.2024.101471","article-title":"Spontaneous expulsion of polytetrafluoroethylene (PTFE) graft in a liver transplant recipient","volume":"14","author":"Saraswathy","year":"2024","journal-title":"J Clin Exp Hepatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.ijscr.2018.03.013","article-title":"Spontaneous migration of thrombosed synthetic vascular graft to the duodenum after living-donor liver transplantation: a case-report","volume":"45","author":"Sultan","year":"2018","journal-title":"Int J Surg Case Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1097\/RCT.0b013e318227a68a","article-title":"Injuries of adjacent organs by the expanded polytetrafluoroethylene grafts in the venoplasty of middle hepatic veins in living-donor liver transplantation: computed tomographic findings and possible risk factors","volume":"35","author":"Kim","year":"2011","journal-title":"J Comput Assist Tomogr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"102","DOI":"10.47717\/turkjsurg.2022.5567","article-title":"Spontaneous and uneventful anal expulsion of expanded polytetrafluoroethylene (e-PTFE) vascular graft after living donor liver transplantation","volume":"41","author":"Egeli","year":"2025","journal-title":"Turkish Journal of Surgery"},{"key":"B14","doi-asserted-by":"publisher","first-page":"71","DOI":"10.4236\/ss.2015.62012","article-title":"Invasion of artificial vascular graft into duodenal bulb after living donor liver transplantation","volume":"6","author":"Hung","year":"2015","journal-title":"Surgical Science"},{"key":"B15","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1002\/lt.24747","article-title":"Intragastric migration of a mesentericoportal polytetrafluoroethylene jump graft after liver transplantation","volume":"23","author":"Esposito","year":"2017","journal-title":"Liver Transpl"}],"container-title":["Frontiers in Transplantation"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1799453\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:52:17Z","timestamp":1781675537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1799453\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":15,"alternative-id":["10.3389\/frtra.2026.1799453"],"URL":"https:\/\/doi.org\/10.3389\/frtra.2026.1799453","relation":{},"ISSN":["2813-2440"],"issn-type":[{"value":"2813-2440","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"article-number":"1799453"}}