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Kazemi K, Samidoost P, Deilami HN, Malek Hosseini SA, Nikeghbalian S, Shamsaeefar A, Dehghani M, Mansoorian M, Gholami S, Khosravi B. A New Consideration in Hepatic Artery Reconstruction in Adult Liver Transplant: Arterial Transposition Versus Extra-Anatomic Jump Grafts. EXP CLIN TRANSPLANT 2017; 15:204-207. [PMID: 28260469 DOI: 10.6002/ect.mesot2016.p82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In some cases of liver transplant, standard hepatic artery reconstruction may be difficult or impossible due to inadequate flow of the recipient's hepatic artery, as a result of stenosis, intimal dissection, or anomalies of the hepatic artery. We compared splenic artery transposition with extra-anatomic jump graft as 2 alternative methods for hepatic artery reconstruction in these situations. MATERIALS AND METHODS We reviewed the files of 2135 liver transplant recipients from March 2011 to February 2016 at the Shiraz Transplant Center. Data of 93 patients with unusual hepatic artery reconstruction were analyzed to assess outcomes, morbidity, mortality, and pre- and posttransplant parameters (both clinical and paraclinical). Patients were divided into 2 groups: 17 with splenic artery transposition (splenic artery group) and 76 with extra-anatomic jump grafts (control group). RESULTS There was only 1 occurrence (5.8%) of hepatic artery thrombosis in the splenic artery group causing extra-anatomic jump graft. However, in the control group, there were 4 occurrences (5.2%) of hepatic artery thrombosis, causing 1 revision of anastomosis and 3 retransplant procedures. No deaths due to hepatic artery complications were reported in the 2 groups. Three-year survival rate was 87.5% in the splenic artery group and 68.9% in the control group. CONCLUSIONS Splenic artery transposition is an acceptable method for hepatic artery reconstruction in deceased-donor liver transplant procedures with no greater rates of complication or morbidity than extra-anatomic jump grafts. Less operation time and better exposure during surgery are advantages of this method.
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Affiliation(s)
- Kourosh Kazemi
- Department of Organ Transplantation, Namazi Hospital, Shiraz, Iran
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Neto JS, Fonseca EA, Cândido HL, Pugliese R, Feier FH, Kondo M, Azambuja RL, Chapchap P. Alternatives for vascular reconstruction in pediatric living donor liver transplantation. Pediatr Transplant 2016; 20:717-722. [PMID: 27174167 DOI: 10.1111/petr.12720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 01/10/2023]
Abstract
Many publications discuss the various strategies for vascular reconstruction (VR) in pediatric LDLT. Having knowledge of alternative techniques is helpful in planning transplants. This article presents three case reports that illustrate some of the alternative techniques for HV, PV, and HA reconstruction in pediatric LDLT. It also reviews the available alternative strategies reported for VR in pediatric LDLT. In the first case, a 13-month-old girl presented a PRETEXT III HB with invasion of the retrohepatic vena cava. An LLS graft HV was anastomosed to a DD iliac vein graft and subsequently implanted in a "standard" fashion in the recipient. In the second case, a 44-month-old boy presented with multifocal HB and portomesenteric thrombosis and the portal inflow was done through a renoportal anastomosis. In the third case, a 22-month-old child with a failed Kasai procedure had extensive HA thrombosis. The HA reconstruction was performed with an interposition of the recipient's IMV graft. The use of alternative techniques for VR in pediatric LDLT is paramount to the success of such a complex procedure. Imaging studies can help transplant surgeons outline surgical strategies and define the best technique to be used in each case.
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Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Helry L Cândido
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Mario Kondo
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Paulo Chapchap
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil
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Right gastroepiploic artery as an alternative for arterial reconstruction in living donor liver transplantation. Case Reports Hepatol 2014; 2014:616251. [PMID: 25478255 PMCID: PMC4247938 DOI: 10.1155/2014/616251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023] Open
Abstract
Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.
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Sanada Y, Wakiya T, Hishikawa S, Hirata Y, Yamada N, Okada N, Ihara Y, Urahashi T, Mizuta K, Kobayashi E. Risk factors and treatments for hepatic arterial complications in pediatric living donor liver transplantation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:463-72. [PMID: 24142418 DOI: 10.1002/jhbp.49] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hepatic artery complications (HAC) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10-year experience with pediatric living donor liver transplantation (LDLT) focusing on the risk factors and treatments for HAC. METHODS Between May 2001 and November 2011, 209 LDLTs were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC. RESULTS The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end-stage liver disease score (≥20), post-transplant laparotomy except for HAC treatment and extra-anatomical hepatic artery reconstruction were independent risk factors for HAC (P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC. The serum aspartate aminotransferase levels pre- and post-treatment for HAC were significantly higher in the surgical group than in the endovascular group (P = 0.016 and P = 0.022, respectively). CONCLUSIONS It is important for recipients with risk factors to maintain strict post-transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.
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Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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Wakiya T, Sanada Y, Mizuta K, Umehara M, Urahashi T, Egami S, Hishikawa S, Nakata M, Hakamada K, Yasuda Y, Kawarasaki H. Hepatic artery reconstruction with the jejunal artery of the Roux-en-Y limb in pediatric living donor liver re-transplantation. Pediatr Transplant 2012; 16:E86-9. [PMID: 21496191 DOI: 10.1111/j.1399-3046.2010.01442.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
When re-anastomosis and re-transplantation becomes necessary after LDLT, arterial reconstruction can be extremely difficult because of severe inflammation and lack of an adequate artery for reconstruction. Frequently, the recipient's HA is not in good condition, necessitating an alternative to the HA. In such cases, the recipient's splenic artery, right gastroepiploic artery or another vessel can be safely used for arterial reconstruction. There have, however, been few reports on using the jejunal artery. Herein, we report our experience with arterial reconstruction using the jejunal artery of the Roux-en-Y limb as an alternative to the HA. A three-yr-old girl who had developed graft failure due to early HA thrombosis after LDLT required re-transplantation. At re-transplantation, an adequate artery for reconstruction was lacking. We reconstructed the artery by using the jejunal artery of the Roux-en-Y limb, as we judged it to be the most appropriate alternative. After surgery, stent was deployed because hepatic blood flow had reduced due to kinking of the anastomosed site, and a favorable outcome was obtained. In conclusion, when an alternative to the HA is required, using the jejunal artery is a feasible alternative.
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Affiliation(s)
- T Wakiya
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Backes A, Gibelli N, Tannuri A, Santos M, Pinho-Apezzato M, Andrade W, Maksoud-Filho J, Queiróz A, Tannuri U. Hepatic Artery Graft in Pediatric Liver Transplantation: Single-Center Experience With 58 Cases. Transplant Proc 2011; 43:177-80. [DOI: 10.1016/j.transproceed.2010.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kim MS, Han YS, Choi DL, Kim JD. Experience with Microsurgical Reconstruction of the Hepatic Artery in 100 Living Donor Liver Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.4.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Min Su Kim
- Department of Surgery, Catholic University of Daegu School of Medicine, Deagu, Korea
| | - Young Seok Han
- Department of Surgery, Catholic University of Daegu School of Medicine, Deagu, Korea
| | - Dong Lak Choi
- Department of Surgery, Catholic University of Daegu School of Medicine, Deagu, Korea
| | - Joo Dong Kim
- Department of Surgery, Catholic University of Daegu School of Medicine, Deagu, Korea
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Kim JD, Choi DL, Han YS. Hepatic Artery Reconstruction Using the Right Gastroepiploic Artery for Hepatic Artery Inflow in a Living Donor Liver Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joo Dong Kim
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Dong Lak Choi
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Young Seok Han
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
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Tannuri U, Tannuri ACA, Watanabe A. Arteriovenous fistula for chronic hemodialysis in pediatric candidates for renal transplantation: Technical details and refinements. Pediatr Transplant 2009; 13:360-4. [PMID: 18785908 DOI: 10.1111/j.1399-3046.2008.01012.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AVFs may be considered the best type of venous access for chronic hemodialysis in pediatric patients with more than 20 kg who are not likely to receive a kidney transplant or be transitioned to peritoneal dialysis within one yr. The aim of the study was to report the experience in the creation of AVFs in pediatric candidates for renal transplantation using microsurgical vascular techniques, with emphasis on the details of the surgical technique. Forty children underwent 50 fistula creations - 31 radial-cephalic, 11 brachial-cephalic, five brachial-basilic and three saphenous-femoral. The vein was anastomosed to the artery in an end-to-lateral fashion by using two separate 8/0 prolene running sutures. The overall patency rate was 76.0%:22 (70.9%) of the radial-cephalic fistulas, nine (81.8%) of the brachial-cephalic, five (100.0%) of the brachial-basilic and two (66.6%) of the saphenous-femoral. There was no significant difference in patency rates between the brachial-cephalic, brachial-basilic and radial-cephalic fistulas. The incidences of fistula patency were not different for patients weighing <20 kg compared with patients weighing >20 kg. AVF remains as a satisfactory method for providing hemodialysis in children. The utilization of microsurgical techniques with some technical refinements described herein permits the achievement of high fistula patency rates.
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Affiliation(s)
- Uenis Tannuri
- Pediatric Surgery Division and Laboratory of Pediatric Surgery (LIM-30), University of Sao Paulo Medical School, Sao Paulo, Brazil.
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Maksoud-Filho JG, Tannuri U, Gibelli NEM, de Pinho-Appezzato ML, da Silva MM, Ayoub AAR, Santos MM, Velhote MCP, de Mello ES, Maksoud JG. Intimal dissection of the hepatic artery after thrombectomy as a cause of graft loss in pediatric living-related liver transplantation. Pediatr Transplant 2008; 12:91-4. [PMID: 18186894 DOI: 10.1111/j.1399-3046.2006.00656.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HAT is the main cause of graft loss in pediatric living-related LTx. Revascularization of the graft by thrombectomy and re-anastomosis has been reported to be effective for graft salvage in cases of HAT and should be attempted when potential donors are not available for emergency re-transplantation. Immediate complications secondary to revascularization attempts in cases of HAT are not described. Late complications are mainly related to biliary tree ischemia. We report a case of child who experienced intimal hepatic artery dissection, which extended into intra-hepatic branches of the artery after a thrombectomy with a Fogarty balloon catheter in an attempt to restore arterial flow after HAT. This complication led to acute deterioration of the graft and the need for emergency re-transplantation.
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D’Albuquerque L, Gonzalez A, Letrinda R, Copstein J, Larrea F, Mansero J, Peron G, Ribeiro M, Oliveira e Silva A. Use of the Splenic Artery for Arterial Reconstruction in Living Donor Liver Transplantation. Transplant Proc 2007; 39:3202-3. [DOI: 10.1016/j.transproceed.2007.03.105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 03/05/2007] [Indexed: 10/22/2022]
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