1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|