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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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Gonultas F, Akbulut S, Barut B, Usta S, Kutluturk K, Kutlu R, Yilmaz S. Usability of Inferior Vena Cava Interposition Graft During Living Donor Liver Transplantation: Is This Approach Always Necessary? J Gastrointest Surg 2020; 24:1540-1551. [PMID: 31385171 DOI: 10.1007/s11605-019-04342-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To share the outcome of caval reconstruction technique in patients who underwent living donor liver transplantation (LDLT) with inferior vena cava (IVC) interposition grafting. METHODS Between January 2009 and December 2018, an artificial or homologous interposition vascular graft was used for the continuity of resected native (IVC) due to various reasons in 29 of 1740 patients who underwent LDLT at our institute. Demographic, clinical, and radiological data were prospectively collected and retrospectively analyzed. RESULTS Sixteen female and 13 male patients ranging 6-67 years of age were included. Right, left, and left lobe lateral segments were used in 22, 5, and 2 patients, respectively. The three leading LDLT indications were primary or idiopathic Budd-Chiari syndrome (BCS) (n = 12), alveolar echinococcosis (n = 7), and secondary BCS (n = 5). The three leading indications for IVC interposition grafting were thrombosis, dense fibrosis, and IVC invasion caused by tumor or echinococcosis. Homologous IVC graft was used in 17, homologous aortic graft in 7, and Dacron graft in 5 patients. Throughout the follow-up period, ascites ± pleural effusion and elevated liver enzymes were detected in 12 and 4 patients, respectively. Stenosis and/or thrombosis requiring one or more procedures such as 1-6 sessions balloon angioplasty, stent, and thrombus aspiration were observed in half of the patients. CONCLUSION Retrohepatic IVC damages are not a contraindication for LDLT. The presence or absence of venous collateral circulation is an important indicator of the need for IVC interposition graft use.
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Affiliation(s)
- Fatih Gonultas
- Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Bora Barut
- Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Koray Kutluturk
- Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
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Abstract
OBJECTIVES This study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). MATERIALS AND METHODS We performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. RESULTS Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n = 5, IVC n = 4, iliac vein n = 1) or synthetic graft (n = 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). CONCLUSIONS Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.
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Jeng LB, Thorat A, Yang HR, Li PC. Venous outflow reconstruction in living donor liver transplantation: Dealing with venous anomalies. World J Transplant 2015; 5:145-153. [PMID: 26722643 PMCID: PMC4689926 DOI: 10.5500/wjt.v5.i4.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/10/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
The reconstruction of the vascular outflow tract of partial liver grafts has received considerable attention in the past, especially in the setting of right liver grafts with undrained segments. Hepatic venous outflow reconstruction is an important factor for successful living donor liver transplantation outcome. However, in presence of undrained anterior sector and presence of multiple short hepatic veins that drain substantial portions of liver, outflow reconstruction without backtable venoplasty may lead to severe graft congestion and subsequent graft dysfunction. Various backtable venoplasty techniques in presence of multiple hepatic veins that can be used in either right- or left-lobe liver transplantation are devised to ensure a single, wide outflow channel. In this overview, various techniques to overcome the hepatic venous variations of liver allograft and outflow reconstruction are discussed.
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Jeng LB, Thorat A, Li PC, Li ML, Yang HR, Yeh CC, Chen TH, Hsu CH, Hsu SC, Poon KS. "V-Plasty" technique using dual synthetic vascular grafts to reconstruct outflow channel in living donor liver transplantation. Surgery 2015; 158:1272-82. [PMID: 25920910 DOI: 10.1016/j.surg.2015.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/28/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The reconstruction of outflow is a crucial step in living donor liver transplantation. This study describes a suitable technique that uses synthetic vascular conduits in presence of multiple draining veins of right lobe of liver and the outcome of the recipients to evaluate safety of using multiple synthetic grafts. METHODS From March 2011 to September 2014, 325 patients underwent right lobe living donor liver transplantation. Expanded polytetra-fluoroethylene (ePTFE) grafts were used in total 155 of the liver allografts. Among these, 16 liver grafts required dual ePTFE grafts to reconstruct the outflow due to presence of multiple hepatic veins. RESULTS The mean diameters for venous branches of segment 5 (V5) and 8 (V8) were 5 mm (range, 4-8 mm) and 7 mm (range, 5-9 mm). The mean diameter of inferior right hepatic veins was 8 mm (7-10 mm). All the recipients who received the right liver with dual ePTFE grafts showed satisfactory inflow and outflow immediately after reconstruction as measured by Doppler flowmetry. Postoperative ultrasonographic studies showed no disturbances in outflow. Protocol dynamic computed tomography performed in the second postoperative month showed 100% patency rates of the artificial grafts. At median follow-up of 24 months graft survival was achieved in 88%, whereas the patency rates of the ePTFE grafts were 100%. CONCLUSION The use of "V-Plasty" technique using dual artificial vascular grafts is a safe and feasible technique in the presence of various allograft venous anomalies & ensures a single venous channel for outflow reconstruction. Our study also suggests that ePTFE graft may be a useful interposition material without serious complications.
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Affiliation(s)
- Long-Bin Jeng
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
| | - Ashok Thorat
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Ping-Chun Li
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Li Li
- College of Medicine, China Medical University, Taichung, Taiwan; Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - Chia-Hao Hsu
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - Kin-Shing Poon
- College of Medicine, China Medical University, Taichung, Taiwan; Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
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