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Lopez-Lopez V, Ferreras D, Eshmuminov D, Brusadin R, Robles-Campos R. The challenge of hepatic vein reconstruction in surgical oncology. Hepatobiliary Surg Nutr 2022; 11:473-476. [PMID: 35693399 PMCID: PMC9186207 DOI: 10.21037/hbsn-22-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/07/2022] [Indexed: 08/30/2023]
Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - David Ferreras
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | - Roberto Brusadin
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
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2
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Une N, Tokodai K, Kanai N, Saitoh Y, Ohta M, Sasaki K, Miyazawa K, Kashiwadate T, Fujio A, Nakanishi W, Miyagi S, Unno M, Kamei T. Living donor liver transplantation for Budd‒Chiari syndrome with right posterior segment graft and patch plasty using the superficial femoral vein: a case report. Surg Case Rep 2021; 7:136. [PMID: 34086114 PMCID: PMC8178427 DOI: 10.1186/s40792-021-01224-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background In living donor liver transplantation (LDLT) for patients with Budd‒Chiari syndrome (BCS), there are several concerns about reconstruction of the inferior vena cava (IVC) and hepatic veins. Herein, we report the case of a patient with BCS who underwent LDLT with right posterior segment graft (RPSG) and patch plasty for reconstruction of the hepatic venous outflow, using the patient’s own superficial femoral vein (SFV). Case presentation A 19-year-old man, who was diagnosed with primary BCS, underwent LDLT. His main hepatic veins were totally obstructed, and membranous stenosis was seen in the IVC. The LDLT donor was his mother; however, liver volumetric analysis showed that only her RPSG was appropriate. In the recipient surgery, 16 cm of the left SFV was harvested and was cut longitudinally and opened. The right hepatic vein (RHV) of the RPSG was anastomosed to the sidewall of the SFV graft. After explantation of native diseased liver was completed, the stenotic and thickened wall of the IVC was widely resected, and a large anastomotic orifice was created. Patch cavoplasty was performed with the RHV‒SFV graft patch. After portal reperfusion started, hepatic venous outflow was satisfactory, and there was no venous graft congestion. Both his postoperative course and his long-term course after discharge were uneventful. Conclusions In LDLT for BCS patients, ingenuity is required for the reconstruction of venous outflow. The SFV patch can be safely harvested from liver transplant recipients and is suitable for venous reconstruction. In addition, RPSG is an alternative type of liver graft for LDLT if a conventional right- or left-lobe graft cannot be used.
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Affiliation(s)
- Norikazu Une
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
| | - Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Norifumi Kanai
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Yoshikatsu Saitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Mineto Ohta
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Kengo Sasaki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Koji Miyazawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Toshiaki Kashiwadate
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Atsushi Fujio
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Wataru Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
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Leal-Leyte P, Valamparampil J, Thambithurai R, Shanmugam NP, Reddy MS, Rela M. Non-standard hepatic venous reconstruction in the setting of absent inferior vena cava in partial graft pediatric liver transplantation-A matched retrospective cohort study. Pediatr Transplant 2021; 25:e13834. [PMID: 32959953 DOI: 10.1111/petr.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
Recipient cava may be unavailable for outflow reconstruction in some children undergoing liver transplantation (PLT) due to caval agenesis, tumor, or fibrotic caval occlusion. Non-standard hepatic venous reconstruction (NHVR) with a direct veno-caval anastomosis or neo-cava reconstruction is necessary in such cases. Retrospective review of all PLT needing NHVR performed in our unit from January 2010 to September 2019 was performed. Outcomes of this group were compared to a 2:1 matched control group who underwent transplantation with standard piggyback technique. Fifteen children (4.9%) of 304 PLT recipients underwent NHVR. Caval agenesis in biliary atresia (n = 5, 33%) and hepatoblastoma infiltrating the cava (n = 4, 27%) were the commonest indications. Ten children had neo-cava reconstruction, while 5 had direct anastomosis to the supra-hepatic caval cuff or right atrium. One child had developed neo-cava thrombosis without graft venous outflow obstruction in the post-operative period. There was no significant difference in major morbidity, need for re-operation (20% vs 16.7%; P = 1.00), hospital stay (24 days, vs 21 days; P = .32), graft & patient survival among the study and control groups. Absent or inadequate recipient cava during PLT with a partial liver graft can be safely managed with technical modifications. Results equivalent to standard piggyback implantation can be achieved.
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Affiliation(s)
- Pilar Leal-Leyte
- Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Chennai, India.,Liver Transplant Study Group Mexico, Hospital Angeles Acoxpa, Mexico City, Mexico
| | - Joseph Valamparampil
- Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Chennai, India
| | - Ravikumar Thambithurai
- Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Chennai, India.,Bharath Institute of Higher Education & Research, Chennai, India
| | - Naresh P Shanmugam
- Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Chennai, India.,Bharath Institute of Higher Education & Research, Chennai, India
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Chennai, India.,Bharath Institute of Higher Education & Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr. Rela Institute & Medical Centre, Chennai, India.,Bharath Institute of Higher Education & Research, Chennai, India
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Szymczak M, Kaliciński PJ, Kowalewski G, Ciopiński M, Markiewicz-Kijewska M, Broniszczak D, Dembowska-Bagińska B, Kościesza A, Brzezińska-Rajszys G, Patkowski W, Stefanowicz M. Inferior Vena Cava and Venous Outflow Reconstruction in Living Donor Liver Transplantation in Children: A Single-Center Retrospective Study and Literature Review. Ann Transplant 2021; 26:e926217. [PMID: 33574216 PMCID: PMC7885297 DOI: 10.12659/aot.926217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background In this report, we present technical problems and solutions used in the reconstruction of the inferior vena cava and graft venous outflow during living donor liver transplantation (LDLT) in children. Material/Methods In 65 grafts out of 379 liver transplantations from living donors, reconstruction of multiple hepatic venous branches and/or IVC was necessary. In 4 cases, cryopreserved deceased donor venous grafts were used for the reconstruction of the IVC and/or HV. Results Follow-up ranged from 2 months to 17.8 years (median 7.2 years). In 4 children, liver re-transplantation was required for a reason not related to venous outflow (biliary complications in 3 patients, graft insufficiency caused by small-for-size syndrome). Two patients died: 1 due to tumor recurrence and 1 due to multi-organ failure. Fifty-nine patients are alive with good liver function. One patient (1.5%) after deceased donor venous graft reconstruction showed symptoms of venous outflow obstruction, which was successfully treated with endovascular balloon angioplasty and stent placement. The remaining 59 transplanted patients do not show any signs of venous outflow obstruction. Conclusions In most cases, the reconstruction of multiple hepatic veins of living donor allografts can successfully be done with local venoplasty, while using cold-stored vein grafts may be helpful in selected cases of LDLT.
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Affiliation(s)
- Marek Szymczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr J Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Grzegorz Kowalewski
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mateusz Ciopiński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Dorota Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Andrzej Kościesza
- Department of Pediatric Radiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Grażyna Brzezińska-Rajszys
- Department of Cardiology and Cardiovascular Interventional Laboratory, The Children's Memorial Health Institute, Warsaw, Poland
| | - Waldemar Patkowski
- Department of General, Transplant and Liver Surgery, Warsaw Medical University, Warsaw, Poland
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
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5
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Hort A, Karpelowsky J, Shun A, Thomas G. Use of a donor iliac vein graft for reconstruction of the inferior vena cava in liver transplantation for hepatoblastoma with caval extension. Pediatr Transplant 2019; 23:e13409. [PMID: 30946509 DOI: 10.1111/petr.13409] [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: 12/20/2018] [Accepted: 03/06/2019] [Indexed: 12/15/2022]
Abstract
Complete microscopic tumor resection is critical for successful treatment of hepatoblastoma, and this may include when liver transplantation is required. For tumors involving the IVC or PV, complete resection should include the involved IVC or PV to ensure full tumor clearance. When this is required, the venous reconstruction at transplant or post-excision can be challenging. We present the management of an 18-month-old girl with PRETEXT Stage IV (P, V, F) hepatoblastoma and IVC involvement, where native caval resection and reconstruction was required. The preoperative staging following neoadjuvant chemotherapy was POSTTEXT Stage IV (P, V, F). An orthotopic liver transplantation was performed using a left lateral segment graft from a deceased adult donor. With native hepatectomy, retrohepatic IVC resection from just above the hepatic venous confluence to just above the entry of the right adrenal vein was performed. For caval reconstruction, a venous graft from a deceased donor was used. The graft included the lower IVC with the right common iliac vein and a short stump of the left common iliac vein. The common iliac was a perfect size match for the IVC, and the three natural ostia matched the upper cava, lower cava, and the outflow from the donor left hepatic vein. The patient had an uneventful postoperative course and remains well and disease-free 2 years after transplant with continued patency of the reconstructed cava. When indicated, a donor iliac vein graft with its natural ostia should be considered in caval reconstruction for pediatric liver transplantation.
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Affiliation(s)
- Amy Hort
- The Department of Surgery, The Children's Hospital Westmead, Part of the Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Jonathan Karpelowsky
- The Department of Surgery, The Children's Hospital Westmead, Part of the Sydney Children's Hospital Network, Westmead, New South Wales, Australia.,Division of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Albert Shun
- The Department of Surgery, The Children's Hospital Westmead, Part of the Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Gordon Thomas
- The Department of Surgery, The Children's Hospital Westmead, Part of the Sydney Children's Hospital Network, Westmead, New South Wales, Australia
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Fernández Soria N, García Novoa M, Rivas Polo J, Fernández Sellés C, de los Ángeles Vázquez M, Marini Milagros M, Gómez Gutiérrez M. Orthotopic Liver Transplantation in an Adult With Biliary Atresia, Situs Inversus, and Inferior Cava Vein Absence: A Case Report. Transplant Proc 2015; 47:2407-9. [DOI: 10.1016/j.transproceed.2015.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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7
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Khorsandi SE, Ruiz Edo N, Vilca-Melendez H, Heaton N. Caval agenesis in the pediatric liver donor. Pediatr Transplant 2015; 19:E139-41. [PMID: 26103057 DOI: 10.1111/petr.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 11/28/2022]
Abstract
The following is the first report of a pediatric organ donor with caval agenesis and the subsequent use of this liver for transplantation. Caval embryology and potential implications of utilizing a donor liver with caval agenesis are reviewed.
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Affiliation(s)
| | - Neus Ruiz Edo
- General Surgery Department, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain
| | | | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, UK
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Angelico R, Stonelake S, Perera DS, Mirza DF, Russell S, Muiesan P, Perera MTPR. Adult liver transplantation in the congenital absence of inferior vena cava. Int J Surg 2015; 22:32-7. [PMID: 26278662 DOI: 10.1016/j.ijsu.2015.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/26/2015] [Accepted: 08/04/2015] [Indexed: 02/04/2023]
Abstract
Whereas congenital absence of inferior vena cava observed in paediatric population more often than not, as an isolated or syndromic variety, this is seldom encountered in adult liver transplant recipients. There appear few sporadic reports in the literature on experience of such anomaly in adults. Given the rarity of situation, surprising encounters of such anomalies may pose challenge to the unprepared transplant surgeon and unfavourable outcomes may even have resulted in under-reportage of this condition. In this brief report we document our recent experience with two such cases and this is supplemented with extensive reference to the literature on classification of such anomalies with the endeavour to document implications of such in the adult liver transplant setting.
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Affiliation(s)
- R Angelico
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 TH, United Kingdom
| | - S Stonelake
- Birmingham Children's Hospital, Birmingham B4 6NH United Kingdom
| | - D S Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 TH, United Kingdom
| | - D F Mirza
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 TH, United Kingdom; Birmingham Children's Hospital, Birmingham B4 6NH United Kingdom
| | - S Russell
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 TH, United Kingdom
| | - P Muiesan
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 TH, United Kingdom; Birmingham Children's Hospital, Birmingham B4 6NH United Kingdom
| | - M T P R Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 TH, United Kingdom; Birmingham Children's Hospital, Birmingham B4 6NH United Kingdom.
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Coelho JCU, Ramos EJB, da Costa MAR, Pissaia A, Junior CAP, Ivantes. Liver transplantation in a patient with complex anomaly of the inferior vena cava. Hepatobiliary Surg Nutr 2014; 3:212-5. [PMID: 25202700 DOI: 10.3978/j.issn.2304-3881.2014.05.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/15/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND After the introduction of noninvasive imaging exams, congenital anomalies of the inferior vena cava (IVC) have become more commonly recognized. We report the first successful orthotopic liver transplantation (OLT) performed in an asymptomatic adult with complex IVC anomaly: duplication of the infrarenal IVC, azygos continuation of the IVC, agenesia of the hepatic portion of the IVC and presence of several anomalous veins communicating the common iliac vein and the IVC of one side with the contralateral side. METHODS This complex anomaly was diagnosed with a venous abdominal angio CT. RESULTS At liver transplantation, the short suprahepatic portion of the IVC was identified and clamped. The right, middle, and left hepatic veins were sectioned and joined in a single, wide cuff, using venoplasty. This single orifice was anastomosed to the suprahepatic IVC of the new liver. No venovenous bypass was employed. The patient had an uneventful postoperative course. A post transplantation venous abdominal angio CT showed normal blood flow at the anastomosis of the hepatic veins of the receptor and the IVC of the new liver. CONCLUSIONS This report is important to alert liver transplant teams of the possibility of complex IVC in asymptomatic adult individuals. Identification of these anatomical anomalies is vital to reduce the risk of serious hemorrhage and other operative complications during OLT.
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Affiliation(s)
- Julio C U Coelho
- Hospital N. S. das Graças, Department of Surgery, Federal University of Paraná, Brazil
| | - Eduardo J B Ramos
- Hospital N. S. das Graças, Department of Surgery, Federal University of Paraná, Brazil
| | - Marco A R da Costa
- Hospital N. S. das Graças, Department of Surgery, Federal University of Paraná, Brazil
| | - Alcindo Pissaia
- Hospital N. S. das Graças, Department of Surgery, Federal University of Paraná, Brazil
| | - Claudia A P Junior
- Hospital N. S. das Graças, Department of Surgery, Federal University of Paraná, Brazil
| | - Ivantes
- Hospital N. S. das Graças, Department of Surgery, Federal University of Paraná, Brazil
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