1
|
Karaca CA, Farajov R, Iakobadze Z, Kilic K, Yilmaz C, Kilic M. Reduced-Size Left Lateral Segment Grafts in Infants Weighing <10 kg. Transplant Proc 2023; 55:1605-1610. [PMID: 37487862 DOI: 10.1016/j.transproceed.2023.03.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/12/2023] [Accepted: 03/30/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Live donor liver transplantation for infants weighing <10 kg has unique complexities, as patient/graft size discrepancies may cause vascular perfusion deficiencies. Failure of the abdominal closure further complicates this already challenging procedure. To overcome these potential problems, several techniques for graft size reduction-either anatomic or nonanatomic-have been proposed in the literature. Technically easier and less time-consuming, nonanatomic size reductions have the advantage of avoiding the risk of injury to the portal pedicle. This study aimed to evaluate and compare the effects of nonanatomic graft size reduction in infants weighing <10 kg with a large estimated preoperative graft recipient weight ratio. METHODS We enrolled 106 infants weighing <10 kg. Of these infants, 50 received reduced-size grafts. The outcomes were compared between the groups. RESULTS No difference was observed between the groups according to survival and vascular or biliary complications. None of the patients required an open abdomen or mesh closure. CONCLUSION Nonanatomic size reduction of left lateral segment grafts can be safely applied without compromising vascular supply, graft function, and patient survival with comparable vascular and biliary complication rates. This technique is safe and efficient in overcoming the complications caused by large-for-size syndrome in infants weighing <10 kg.
Collapse
Affiliation(s)
- Can A Karaca
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey.
| | - Rasim Farajov
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Zaza Iakobadze
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Kamil Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Cahit Yilmaz
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey; Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Murat Kilic
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey; Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| |
Collapse
|
2
|
da Fonseca EA, Feier FH, Costa CM, Benavides MAR, Vincenzi R, de Oliveira Roda Vincenzi KM, Pugliese RPS, Porta G, Miura IK, de Oliveira CMV, Chapchap P, Neto JS. Hepatic venous reconstruction of the left lateral segment with emphasis on anomalous hepatic vein in pediatric liver transplantation. Liver Transpl 2023; 29:827-835. [PMID: 36847137 DOI: 10.1097/lvt.0000000000000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/05/2023] [Indexed: 03/01/2023]
Abstract
Left lateral segment grafts have become a suitable option in pediatric liver transplantation (PLT). The correlation between hepatic vein (HV) reconstruction and outcome is relevant when assessing the safe use of these grafts. We retrospectively reviewed the medical records prospectively collected from a pediatric living donor liver transplantation database and conducted a comparative analysis of the different left lateral segment graft types according to HV reconstruction. Donor, recipient, and intraoperative variables were analyzed. Post-transplant outcomes included vascular complications such as hepatic vein outflow obstruction, early (≤30 d) and late (>30 d) PVT, hepatic artery thrombosis, and graft survival. From February 2017 to August 2021, 303 PLTs were performed. According to venous anatomy, the distribution of the left lateral segment was as follows: single HV (type I) in 174 (57.4%), close HVs, simple venoplasty for reconstruction (type II) in 97 (32.01%), anomalous hepatic vein (AHV) with a distance between the HVs orifices that allowed simple venoplasty (type IIIA) in 25 (8.26%) and AHV with a distance between the HVs orifices requiring homologous venous graft interposition (type IIIB) in 07 (2.31%) grafts. Type IIIB grafts came from male donors ( p =0.04) and had a higher mean donor height ( p =0.008), a higher mean graft weight, and a higher graft-to-recipient weight ratio, both p =0.002. The median follow-up time was 41.4 months. The overall cumulative graft survival was 96.3%, and comparative graft survival showed no difference (log-rank p =0.61). No hepatic vein outflow obstructions were observed in this cohort study. There was no statistically significant difference in the post-transplant outcomes between the graft types. The venous reconstruction of the AHV with homologous venous graft interposition had similar outcomes in the short and long term.
Collapse
Affiliation(s)
- Eduardo Antunes da Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Flavia Heinz Feier
- Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Carolina Magalhães Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcel Albeiro Ruiz Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Karina Moreira de Oliveira Roda Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pereira Sustovich Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Irene Kazuo Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Caio Marcio Vieira de Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Outflow reconstruction of left lateral graft with two widely spaced hepatic veins in pediatric living donor liver transplantation. Surgery 2022; 172:391-396. [PMID: 35210103 DOI: 10.1016/j.surg.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/06/2021] [Accepted: 01/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Living donor liver transplantation using the left lateral segment of the liver is the most common type of pediatric liver transplantation. An appropriate surgical approach is crucial for decreasing the risk of vascular complications using these grafts with anatomical variations. METHODS Between January 2017 and December 2020, 631 living donor liver transplantations using left lateral segment grafts were performed at Tianjin First Central Hospital. The grafts from 162 (25.7%) donors have 2 hepatic vein openings. A total number of 21 transplantations using left lateral segment grafts with 2 widely spaced hepatic vein openings were performed. In group 1, the unification venoplasty technique with interposition vein graft was used at the back table for the reconstruction of hepatic vein from grafts. In group 2, dual hepatic vein reconstructions were performed, in which venoplasty of recipients' left hepatic vein, middle hepatic vein, and inferior vena cava was performed to create a large orifice for anastomosis with segment Ⅱ hepatic vein from the graft. Segment III hepatic vein from the graft was anastomosed with the recipient's right hepatic vein. The incidence, treatment, and outcomes of hepatic venous outflow obstruction were compared between the 2 groups. RESULTS The median follow-up time was 12.8 months. There was no significant difference in the incidence of hepatic venous outflow obstruction between the 2 groups. CONCLUSION Dual hepatic vein reconstruction is an alternate surgical option for grafts with 2 widely spaced hepatic veins, and it is associated with ideal graft recovery and vascular condition. However, long-term follow-up is still needed to verify the efficacy and safety of this approach.
Collapse
|
4
|
Flynn E, Huang JY, Hardikar W, Herd L, Hodgson A, Monagle P. Antithrombotic management and thrombosis rates in children post-liver transplantation: A case series and literature review. Pediatr Transplant 2019; 23:e13420. [PMID: 31012220 DOI: 10.1111/petr.13420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 12/14/2022]
Abstract
Thrombosis is a major postoperative complication in pediatric liver transplantation. There is marked heterogeneity in prophylactic antithrombotic therapies used, without established guidelines. This review summarizes current worldwide incidence of thrombotic events and compares antithrombotic therapies in children post-liver transplant, with comparison to our institution's experience. Of the twenty-three articles with sufficient detail to compare antithrombotic regimens, the overall incidence of thrombosis ranged from 2.4% to 17.3%. Incidence of HAT ranged from 0% to 28.1%, of HVT from 0% to 4.7%, of PVT from 1.5% to 11.2%, and of IVC thrombosis from 0% to 2.8%. Re-transplantation due to thrombosis ranged from 0% to 4.8%. Prophylactic antithrombotic therapies varied between studies, and bleeding complications were infrequently reported. Since 2010, 96 children underwent 100 liver transplants at our institution with thrombosis incidence comparable to international literature (HAT 6%, PVT 5%, IVC 1%, and HVT 0%). Re-transplantation due to thrombosis occurred in 2% and major bleeding occurred in 10%. The prophylactic antithrombotic therapies used post-liver transplantation in children remain varied. Low rates of thrombosis have been reported with antiplatelet use both with and without anticoagulation. Standard definitions and consistent reporting of bleeding complications are required, in addition to thrombosis rates, so that true risk-benefit assessment of reported regimes can be understood.
Collapse
Affiliation(s)
- Elise Flynn
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Joanna Y Huang
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia.,Hematology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Winita Hardikar
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Lauren Herd
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Alexandra Hodgson
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paul Monagle
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia.,Hematology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
5
|
Zeytunlu M, Uğuz A, Ünalp Ö, Ergün O, Karasu Z, Günşar F, Akarca U, Yılmaz F, Turan İ, Nart D, Tekin F, Özütemiz Ö, Ulukaya S, Deniz N, Aydoğdu S, Özgenç F, Tasçı E, Sertöz R, Parıldar M, Elmas N, Harman M, Güler E, Kısmalı E, Akyol R, Yamazhan T, Taşbakan M, Tiftikcioğlu Y, Bacakoğlu F, Nalbantgil S, Noyan A, Karapınar B, Kılınç A, Uyar M, Demirağ K, Özalp S, Özdemir N, Aras S, Altuğ N. Results of 1001 liver transplantations in 23 years: Ege University experience. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:664-668. [PMID: 30381274 PMCID: PMC6284687 DOI: 10.5152/tjg.2018.18058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.
Collapse
Affiliation(s)
- Murat Zeytunlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Alper Uğuz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Ünalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Akarca
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Yılmaz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Nart
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nuri Deniz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Tasçı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rüçhan Sertöz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Parıldar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nevra Elmas
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Erkan Kısmalı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rahmi Akyol
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Tansu Yamazhan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Taşbakan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Yiğit Tiftikcioğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Feza Bacakoğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sanem Nalbantgil
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ayşin Noyan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Karapınar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Arda Kılınç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mehmet Uyar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Kubilay Demirağ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Özalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nebile Özdemir
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sinem Aras
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nurşen Altuğ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| |
Collapse
|
6
|
Fukuda A, Sakamoto S, Sasaki K, Narumoto S, Kitajima T, Hirata Y, Hishiki T, Kasahara M. Modified triangular hepatic vein reconstruction for preventing hepatic venous outflow obstruction in pediatric living donor liver transplantation using left lateral segment grafts. Pediatr Transplant 2018; 22:e13167. [PMID: 29484815 DOI: 10.1111/petr.13167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 12/15/2022]
Abstract
HVOO can be a critical complication in pediatric LDLT. The aim of this study was to evaluate a modified triangular technique of hepatic vein reconstruction for preventing HVOO in pediatric LDLT. A total of 298 pediatric LDLTs were performed using a left lateral segment graft by 2 methods for reconstruction of the hepatic vein. In 177 recipients, slit-shaped anastomosis was indicated with partial clamp of the IVC. A total of 121 recipients subjected to the modified triangular anastomosis with total clamp of the IVC. We compared the incidence of hepatic vein anastomotic complications between these 2 methods. Nine of the 177 cases (5.3%) treated with the conventional technique were diagnosed with outflow obstruction. All 9 cases underwent hepatic vein reconstruction with the slit-shaped hepatic vein anastomosis. In contrast, there were no cases of outflow obstruction in the 121 cases treated with the modified triangular anastomosis. The modified triangular technique of hepatic vein reconstruction with total clamping of the IVC was useful for preventing HVOO in pediatric LDLT.
Collapse
Affiliation(s)
- Akinari Fukuda
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kengo Sasaki
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Soichi Narumoto
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiro Kitajima
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshihiro Hirata
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoro Hishiki
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
7
|
Galloux A, Pace E, Franchi-Abella S, Branchereau S, Gonzales E, Pariente D. Diagnosis, treatment and outcome of hepatic venous outflow obstruction in paediatric liver transplantation: 24-year experience at a single centre. Pediatr Radiol 2018; 48:667-679. [PMID: 29468367 DOI: 10.1007/s00247-018-4079-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/23/2017] [Accepted: 01/12/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hepatic venous outflow obstruction after paediatric liver transplantation is an unusual but critical complication. OBJECTIVES To review the incidence, diagnosis and therapeutic modalities of hepatic venous outflow obstruction from a large national liver transplant unit. MATERIALS AND METHODS During the period from October 1992 to March 2016, 917 liver transplant procedures were performed with all types of grafts in 792 children. Transplants suspected to have early or delayed venous outflow obstruction were confirmed by percutaneous venography or surgical revision findings. Therapeutic intervention, recurrence and outcome were evaluated. RESULTS Twenty-six of 792 children (3.3%) experienced post-transplant hepatic venous outflow obstruction. These patients had been diagnosed from 1 day to 8.75 years after transplantation. Six occurred during the early post-transplant period; in three of them, the graft was lost. Seventeen patients were initially treated by balloon angioplasty with success; 11 of these experienced recurrences. Four stents were implanted; one was complicated by definitive occlusion. Three of the five surgical revisions were successful. The initial stenosis involved the inferior vena cava in 10 grafts, in isolation or associated with hepatic vein involvement. Mean follow-up was 79 months after transplantation. Eight grafts were lost. CONCLUSION Acute postoperative hepatic venous outflow obstruction was associated with poor prognosis. Diagnostic venography should be performed if there is any suspicion of venous outflow obstruction, even if first-line examinations are normal. Stenosis frequently involved the inferior vena cava. Angioplasty was a safe and efficient treatment for venous outflow obstruction despite frequent recurrence.
Collapse
Affiliation(s)
- Alexis Galloux
- AP-HP, Bicêtre Hospital, Pediatric Radiology Department, 78 rue du Gal Leclerc, 94270, Le Kremlin Bicêtre, France.
| | - Erika Pace
- AP-HP, Bicêtre Hospital, Pediatric Radiology Department, 78 rue du Gal Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Stephanie Franchi-Abella
- AP-HP, Bicêtre Hospital, Pediatric Radiology Department, 78 rue du Gal Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Faculty of Medicine, Paris Sud University, Le Kremlin Bicêtre, France.,AP-HP, Bicêtre Hospital, Pediatric Surgery Department, Le Kremlin Bicêtre, France
| | - Emmanuel Gonzales
- Faculty of Medicine, Paris Sud University, Le Kremlin Bicêtre, France.,AP-HP, Bicêtre Hospital, Pediatric Hepatology Department, Le Kremlin Bicêtre, France
| | - Daniele Pariente
- AP-HP, Bicêtre Hospital, Pediatric Radiology Department, 78 rue du Gal Leclerc, 94270, Le Kremlin Bicêtre, France
| |
Collapse
|
8
|
Abdelaziz O, Attia H. Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications. World J Gastroenterol 2016; 22:6145-72. [PMID: 27468207 PMCID: PMC4945976 DOI: 10.3748/wjg.v22.i27.6145] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intra-operative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.
Collapse
|
9
|
Cherian PT, Mishra AK, Bangaari A, Kota V, Sathyanarayanan M, Raya R, Rela M. Better innovate than compromise: a novel hepatic outflow reconstruction technique in pediatric living donor liver transplantation. Pediatr Transplant 2015; 19:E56-61. [PMID: 25655683 DOI: 10.1111/petr.12437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 12/22/2022]
Abstract
Pediatric LDLT using donors with unfavorable vascular anatomy is challenging in terms of donor safety, and complexity of reconstruction in the recipient. We describe an innovative technique of hepatic venous outflow reconstruction involving the recipient RHV, in the presence of a rudimentary RHV in the donor. The postoperative course of the donor and recipient was uneventful with satisfactory venous outflow in both. This technique avoided the use of prosthetic material, an important consideration given the recipient age and requirement for growth. This shows that donors previously considered unsuitable for donation can be utilized safely as long as principles of vascular anastomosis are adhered to. Moreover, it highlights that innovation is sometimes necessary to avoid compromise in donor safety.
Collapse
Affiliation(s)
- P Thomas Cherian
- Department of HPB and Liver Transplantation, Global Hospitals, Hyderabad, Telangana, India; Institute of Liver Disease & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | |
Collapse
|
10
|
Benetatos N, Scalera I, Isaac JR, Mirza DF, Muiesan P. Complex outflow anatomy in left lateral lobe graft and modified venous reconstruction in pediatric living donor liver transplantation. Transpl Int 2014; 27:e105-8. [DOI: 10.1111/tri.12388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 02/25/2014] [Accepted: 06/17/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Nikolaos Benetatos
- The Liver Unit; Queen Elizabeth Hospital; University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| | - Irene Scalera
- The Liver Unit; Queen Elizabeth Hospital; University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| | - John R. Isaac
- The Liver Unit; Queen Elizabeth Hospital; University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| | - Darius F. Mirza
- The Liver Unit; Queen Elizabeth Hospital; University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| | - Paolo Muiesan
- The Liver Unit; Queen Elizabeth Hospital; University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| |
Collapse
|
11
|
Rao W, Sun LY, Zhu ZJ, Chen G, Sun XY, Gao W, Shi R. Successful percutaneous transluminal balloon dilatation for hepatic venous outflow obstruction after pediatric liver transplantation: A series of cases. Hepatol Res 2013; 43:1321-6. [PMID: 23489344 DOI: 10.1111/hepr.12086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 02/08/2023]
Abstract
AIM Whether percutaneous transluminal balloon dilatation (PTBD) or stent placement should be used in children with hepatic venous outflow obstruction (HVOO) is still controversial. The aim of the present study was to retrospectively describe experience in diagnosis and treatment of HVOO and to evaluate the outcome of PTBD in HVOO patients after pediatric liver transplantation (P-LT). METHODS From January 2001 to January 2011, 54 children received P-LT at our center. The clinical features of children with HVOO analyzed included demography, type of donor and liver transplant, the new-onset symptoms, liver function test, interventional examination, and treatment and outcome. RESULTS Three children were treated successfully with PTBD without stenting. All patients received percutaneous interventional management successfully. In the total of eight episodes of PTBD across the stenosis, the mean pressure gradient ± standard deviation was 16.6 ± 7.90 mmHg before PTBD and 6.8 ± 2.27 mmHg after PTBD. The difference was significant (P < 0.05). All of the three HVOO patients were still surviving with primary graft functioning normally until the last follow up. CONCLUSION HVOO after P-LT should be taken seriously. PTBD is an effective and safe treatment for HVOO in younger patients subjected to P-LT and re-venoplasty is recommended even in patients with recurrent HVOO.
Collapse
Affiliation(s)
- Wei Rao
- Department of Organ Transplantation, First Central Hospital, Tianjin, China
| | | | | | | | | | | | | |
Collapse
|
12
|
Tannuri U, Santos MM, Tannuri ACA, Gibelli NE, Moreira A, Carnevale FC, Ayoub AA, Maksoud-Filho JG, Andrade WC, Velhote MCP, Silva MM, Pinho-Apezzato ML, Miyatani HT, Guimarães RRN. Which is the best technique for hepatic venous reconstruction in pediatric living-donor liver transplantation? Experience from a single center. J Pediatr Surg 2011; 46:1379-84. [PMID: 21763838 DOI: 10.1016/j.jpedsurg.2010.11.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/21/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE The introduction of the piggyback technique for reconstruction of the liver outflow in reduced-size liver transplants for pediatric patients has increased the incidence of hepatic venous outflow block (HVOB). Here, we proposed a new technique for hepatic venous reconstruction in pediatric living-donor liver transplantation. METHODS Three techniques were used: direct anastomosis of the orifice of the donor hepatic veins and the orifice of the recipient hepatic veins (group 1); triangular anastomosis after creating a wide triangular orifice in the recipient inferior vena cava at the confluence of all the hepatic veins (group 2); and a new technique, which is a wide longitudinal anastomosis performed at the anterior wall of the inferior vena cava (group 3). RESULTS In groups 1 and 2, the incidences of HVOB were 27.7% and 5.7%, respectively. In group 3, no patient presented HVOB (P = .001). No difference was noted between groups 2 and 3. CONCLUSIONS Hepatic venous reconstruction in pediatric living-donor liver transplantation must be preferentially performed by using a wide longitudinal incision at the anterior wall of the recipient inferior vena cava. As an alternative technique, triangulation of the recipient inferior vena cava, including the orifices of the 3 hepatic veins, may be used.
Collapse
Affiliation(s)
- Uenis Tannuri
- Pediatric Surgery Division and Liver Transplantation Unit, Children's Institute, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Sakamoto S, Egawa H, Kanazawa H, Shibata T, Miyagawa-Hayashino A, Haga H, Ogura Y, Kasahara M, Tanaka K, Uemoto S. Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto University experience. Liver Transpl 2010; 16:1207-14. [PMID: 20879019 DOI: 10.1002/lt.22135] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The goals of this study were to evaluate the incidence of hepatic venous outflow obstruction (HVOO) in pediatric patients after living donor liver transplantation (LDLT) using left-sided lobe grafts and to assess the therapeutic modalities used for the treatment of this complication at a single center. Four hundred thirteen primary LDLT procedures were performed with left-sided lobe grafts between 1996 and 2006. All transplants identified with HVOO from a cohort of 380 grafts with survival greater than 90 days were evaluated with respect to the patient demographics, therapeutic intervention, recurrence, and outcome. Seventeen cases (4.5%) were identified with HVOO. Eight patients experienced recurrence after the initial balloon venoplasty. Two patients finally required stent placement after they experienced recurrence shortly after the initial balloon venoplasty. A univariate analysis revealed that a smaller recipient-to-donor body weight ratio and the use of reduced grafts were statistically significant risk factors. The cases with grafts with multiple hepatic veins had a higher incidence of HVOO. In conclusion, the necessity of repeated balloon venoplasty and stent placement was related to poor graft survival. Therefore, the prevention of HVOO should be a high priority in LDLT. When grafts with multiple hepatic veins and/or significant donor-recipient size mismatching are encountered, the use of a patch graft is recommended. Stent placement should be carefully considered because of the absence of data on the long-term patency of stents and stent-related complications. New stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO.
Collapse
Affiliation(s)
- Seisuke Sakamoto
- Departments of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Heffron TG, Pillen T, Smallwood G, Henry S, Sekar S, Casper K, Solis D, Tang W, Fasola C, Romero R. Incidence, impact, and treatment of portal and hepatic venous complications following pediatric liver transplantation: a single-center 12 year experience. Pediatr Transplant 2010; 14:722-9. [PMID: 20345612 DOI: 10.1111/j.1399-3046.2009.01259.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PVT or PVS and HVOO are known causes of graft and patient loss after pediatric liver transplantation. Increased incidences of these complications have been reported in partial livers including DDSLT or LDLT. From 1997 to 2008, 241 consecutive pediatric patients received 271 hepatic grafts at a single center. Median follow-up is 1856 days. Surgical technique, demographics, lab values, and radiologic imaging procedures were obtained utilizing OTTR to evaluate the relationship of portal and hepatic complications with risk factors, patient and graft survival. Grafts were composed of 115/271 (42.4%) partial livers of which 90 (33.2%) were DDSLT and 25 (9.2%) LDLT. Of 271 patients, 156 (57.6%) received whole-sized grafts. There were six PVC in five patients with one patient requiring retransplantation (0.34%) and no patient deaths. Utilizing all three hepatic vein orifices on the recipient hepatic vena cava and the donor hepatic vein cut short enables a wide hepatic outflow tract unlikely to twist. None of the 241 patients developed early or late complications of the hepatic vein. None of the last 128 consecutive patients who received 144 grafts over seven and a half yr have developed either early or late complications of the hepatic or portal vein. Partial-graft actuarial survival was similar to whole-graft survival (87.2% vs. 85.3% at one yr; 76.6% vs. 80.2 at three yr; p = 0.488). Likewise, patient survival was similar between partial grafts and whole grafts (93.8% vs. 93.1% at one yr; 89.8% vs. 87.2% at three yr; p = 0.688) with median follow-up of 1822 (+/-1334) days. Patients receiving partial livers were significantly younger and smaller than patients receiving whole livers (p < 0.001). Portal and hepatic venous complications may have negative effects on patient or graft survival after pediatric liver transplantation. In our series, there was one graft and no patient loss related to portal or hepatic venous complications after pediatric liver transplantation over 12 yr.
Collapse
|