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Salvage dual graft living donor liver transplantation after major hepatectomy.

Kim JD, Choi DL, Han YS - Ann Surg Treat Res (2014)

Bottom Line: During operation, portal vein anastomosis of the right lobe graft was performed using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft.Adequate graft inflow was demonstrated by postoperative imaging studies.He has been doing well with normal graft function for 31 months.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.

ABSTRACT
Salvage living donor liver transplantation (LDLT) after major hepatectomy has been considered a challenging procedure due to operative complexity. We report a successful case of salvage dual graft LDLT after right hepatectomy. A 48-year-old male was transferred to Daegu Catholic University Medical Center because of duodenal variceal bleeding. He underwent right hepatectomy due to hepatocellular carcinoma four years prior. We performed LDLT with dual graft from his wife and sister. During operation, portal vein anastomosis of the right lobe graft was performed using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft. Adequate graft inflow was demonstrated by postoperative imaging studies. He has been doing well with normal graft function for 31 months. Salvage dual graft LDLT could be undertaken successfully in patients with prior major hepatectomy under accurate preoperative planning and proper surgical techniques.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph (A) and illustration (B) of vascular and biliary reconstruction of salvage dual graft living donor liver transplantation. Cryopreserved iliac vein conduit was interposed from portal vein of right-sided graft to right portal vein stump of recipient (arrow) and recipient's right gastroepiploic artery (arrowhead) was anastomosed to left hepatic artery of left-sided graft.
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Figure 2: Intraoperative photograph (A) and illustration (B) of vascular and biliary reconstruction of salvage dual graft living donor liver transplantation. Cryopreserved iliac vein conduit was interposed from portal vein of right-sided graft to right portal vein stump of recipient (arrow) and recipient's right gastroepiploic artery (arrowhead) was anastomosed to left hepatic artery of left-sided graft.

Mentions: The first liver graft during the donor operations (right lobe: actual graft weight, 460 g; GRWR, 0.71%) was harvested from the younger sister, and the second liver graft (left lobe: actual graft weight, 211 g; GRWR, 0.32%) was harvested from his wife. The total graft weight was 617 g, and GRWR was 0.95%. A cryopreserved iliac vein graft was prepared to produce a portal venous conduit for PV reconstruction to the right lobe graft, because there was insufficient right PV to secure a classic anastomosis. This venous conduit was interposed to the PV orifice of the right graft to substitute for the recipient's right PV on the back table. The reconstruction procedures for dual LDLT with right and left lobes have been described in various reports in detail, including hepatic vein reconstruction for dual grafts [4]. The interposition vein of the right graft PV was anastomosed to the recipient's right portal stump without kinking (Fig. 2), followed by an end-to-end anastomosis of the left graft PV. The only remnant left hepatic artery was used for hepatic artery reconstruction of the right graft. However, additional inflow was needed for the other graft, so the right gastroepiploic artery (RGEA) was used as arterial inflow for the left graft (Fig. 2). The bile duct of the right graft was reconstructed with duct-to-duct anastomosis, and the bile duct of the left graft was reconstructed with hepaticojejunostomy. Intraoperative and postoperative Doppler ultrasound studies and three-dimensional CT revealed good hepatic artery, PV, and hepatic vein flow to both grafts (Fig. 3). The patient has recovered well with normal graft function and has been doing well for 31 months after LDLT.


Salvage dual graft living donor liver transplantation after major hepatectomy.

Kim JD, Choi DL, Han YS - Ann Surg Treat Res (2014)

Intraoperative photograph (A) and illustration (B) of vascular and biliary reconstruction of salvage dual graft living donor liver transplantation. Cryopreserved iliac vein conduit was interposed from portal vein of right-sided graft to right portal vein stump of recipient (arrow) and recipient's right gastroepiploic artery (arrowhead) was anastomosed to left hepatic artery of left-sided graft.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127898&req=5

Figure 2: Intraoperative photograph (A) and illustration (B) of vascular and biliary reconstruction of salvage dual graft living donor liver transplantation. Cryopreserved iliac vein conduit was interposed from portal vein of right-sided graft to right portal vein stump of recipient (arrow) and recipient's right gastroepiploic artery (arrowhead) was anastomosed to left hepatic artery of left-sided graft.
Mentions: The first liver graft during the donor operations (right lobe: actual graft weight, 460 g; GRWR, 0.71%) was harvested from the younger sister, and the second liver graft (left lobe: actual graft weight, 211 g; GRWR, 0.32%) was harvested from his wife. The total graft weight was 617 g, and GRWR was 0.95%. A cryopreserved iliac vein graft was prepared to produce a portal venous conduit for PV reconstruction to the right lobe graft, because there was insufficient right PV to secure a classic anastomosis. This venous conduit was interposed to the PV orifice of the right graft to substitute for the recipient's right PV on the back table. The reconstruction procedures for dual LDLT with right and left lobes have been described in various reports in detail, including hepatic vein reconstruction for dual grafts [4]. The interposition vein of the right graft PV was anastomosed to the recipient's right portal stump without kinking (Fig. 2), followed by an end-to-end anastomosis of the left graft PV. The only remnant left hepatic artery was used for hepatic artery reconstruction of the right graft. However, additional inflow was needed for the other graft, so the right gastroepiploic artery (RGEA) was used as arterial inflow for the left graft (Fig. 2). The bile duct of the right graft was reconstructed with duct-to-duct anastomosis, and the bile duct of the left graft was reconstructed with hepaticojejunostomy. Intraoperative and postoperative Doppler ultrasound studies and three-dimensional CT revealed good hepatic artery, PV, and hepatic vein flow to both grafts (Fig. 3). The patient has recovered well with normal graft function and has been doing well for 31 months after LDLT.

Bottom Line: During operation, portal vein anastomosis of the right lobe graft was performed using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft.Adequate graft inflow was demonstrated by postoperative imaging studies.He has been doing well with normal graft function for 31 months.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.

ABSTRACT
Salvage living donor liver transplantation (LDLT) after major hepatectomy has been considered a challenging procedure due to operative complexity. We report a successful case of salvage dual graft LDLT after right hepatectomy. A 48-year-old male was transferred to Daegu Catholic University Medical Center because of duodenal variceal bleeding. He underwent right hepatectomy due to hepatocellular carcinoma four years prior. We performed LDLT with dual graft from his wife and sister. During operation, portal vein anastomosis of the right lobe graft was performed using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft. Adequate graft inflow was demonstrated by postoperative imaging studies. He has been doing well with normal graft function for 31 months. Salvage dual graft LDLT could be undertaken successfully in patients with prior major hepatectomy under accurate preoperative planning and proper surgical techniques.

No MeSH data available.


Related in: MedlinePlus