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Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review.

Jianyong L, Jingcheng H, Wentao W, Lunan Y, Jichun Z, Bing H, Ding Y - Medicine (Baltimore) (2015)

Bottom Line: Considering the donor shortage and the drawbacks of immunosuppressive therapy, ex vivo liver resection followed by autotransplantation may be the first choice for these patients.This graft included the following regions: the bilateral great saphenous vein, part of the retrohepatic inferior vena and the middle hepatic vein with no invasion, the inferior mesenteric vein, and part of the side wall of the infrahepatic vena cava.This patient had an uneventful postoperative recovery; currently, she has been enjoying a normal life and is 12 months postoperative with no immunosuppressive therapy or AE recurrence.In conclusion, ex vivo liver resection followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting might be a useful surgical practice for advanced AE.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Liver Surgery (LJ, HO, WW); Vascular surgery (ZJ, HB, YD); ; Transplantation Center (YL), West China Hospital of Sichuan University, Chengdu, China.

ABSTRACT
Alveolar echinococcosis (AE) of the liver is a rare disease. In advanced cases of this parasitic disease, the inferior vena cava (IVC) can be invaded; in these cases, the optimal treatment is liver transplantation and replacement of the IVC. Considering the donor shortage and the drawbacks of immunosuppressive therapy, ex vivo liver resection followed by autotransplantation may be the first choice for these patients. We report the first case of advanced AE successfully treated by an ex vivo liver resection, followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting. This graft included the following regions: the bilateral great saphenous vein, part of the retrohepatic inferior vena and the middle hepatic vein with no invasion, the inferior mesenteric vein, and part of the side wall of the infrahepatic vena cava. This patient had an uneventful postoperative recovery; currently, she has been enjoying a normal life and is 12 months postoperative with no immunosuppressive therapy or AE recurrence.In conclusion, ex vivo liver resection followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting might be a useful surgical practice for advanced AE.

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A: An enhanced CT indicated a large lesion in the right lobe that invaded the left bile duct, and the left biliary ducts were dilated due to the obstruction; B and C: a preoperative MRI scan indicated an invasion of the right and middle hepatic vein and the retrohepatic segment of the IVC; D: a preoperative MRI scan indicated an invading left intrahepatic vascular tree and bile duct in the first porta hepatis; E: a large alveolar echinococcosis target in the right lobe and strong widespread adhesions with surrounding tissues made the recipient hepatectomy more difficult than in patients with other liver diseases; F: the intraoperative findings confirmed the invasion and circumvolution of the retrohepatic segment of the inferior vena cava. CT = computerized tomography, IVC = inferior vena cava.
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Figure 1: A: An enhanced CT indicated a large lesion in the right lobe that invaded the left bile duct, and the left biliary ducts were dilated due to the obstruction; B and C: a preoperative MRI scan indicated an invasion of the right and middle hepatic vein and the retrohepatic segment of the IVC; D: a preoperative MRI scan indicated an invading left intrahepatic vascular tree and bile duct in the first porta hepatis; E: a large alveolar echinococcosis target in the right lobe and strong widespread adhesions with surrounding tissues made the recipient hepatectomy more difficult than in patients with other liver diseases; F: the intraoperative findings confirmed the invasion and circumvolution of the retrohepatic segment of the inferior vena cava. CT = computerized tomography, IVC = inferior vena cava.

Mentions: A 44-year-old woman with a yellowish discoloration of the skin and eyes due to advanced stage AE was transferred to our center; she came from Lhasa, the capital of the Tibetan autonomous region, which is a pasturing area in southwestern China. Three years ago, the patient was diagnosed with AE by an enhanced computerized tomography (CT); an indirect echinococcal hemagglutination test was positive, and an anti-E granulosus IgG test was positive. She refused to accept a liver resection and only took albendazole (400 mg) 3 times daily; however, the patient's status worsened due to the jaundice, abnormal coagulation, and an increasing amount and prolonged duration of menstruation. A standard laboratory biochemical analysis revealed the following results: hemoglobin: 49 g/L, total bilirubin: 269.5 μmol/L, direct bilirubin: 248.1 μmol/L, aspartate aminotransferase: 106 IU/L, alanine aminotransferase: 55 IU/L, albumin: 25 g/L, prothrombin time: 18 seconds, and international normalized ratio: 1.59. An enhanced abdominal CT indicated a large lesion in the right lobe and segment IV; the target invaded the left bile duct, and the left biliary ducts were dilated due to the obstruction (Figure 1A). A CT scan of the head and lungs found no extra-liver targets; therefore, the treatment in the hospital included a transfusion and persistent percutaneous transhepatic cholangial drainage (PTCD). After multidisciplinary discussions, with nearly 3 months of persistent drainage, the patient's liver function recovered to a normal level. Then, the ex vivo liver resection followed by autotransplantation strategy was introduced to the patient and her family.


Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review.

Jianyong L, Jingcheng H, Wentao W, Lunan Y, Jichun Z, Bing H, Ding Y - Medicine (Baltimore) (2015)

A: An enhanced CT indicated a large lesion in the right lobe that invaded the left bile duct, and the left biliary ducts were dilated due to the obstruction; B and C: a preoperative MRI scan indicated an invasion of the right and middle hepatic vein and the retrohepatic segment of the IVC; D: a preoperative MRI scan indicated an invading left intrahepatic vascular tree and bile duct in the first porta hepatis; E: a large alveolar echinococcosis target in the right lobe and strong widespread adhesions with surrounding tissues made the recipient hepatectomy more difficult than in patients with other liver diseases; F: the intraoperative findings confirmed the invasion and circumvolution of the retrohepatic segment of the inferior vena cava. CT = computerized tomography, IVC = inferior vena cava.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554170&req=5

Figure 1: A: An enhanced CT indicated a large lesion in the right lobe that invaded the left bile duct, and the left biliary ducts were dilated due to the obstruction; B and C: a preoperative MRI scan indicated an invasion of the right and middle hepatic vein and the retrohepatic segment of the IVC; D: a preoperative MRI scan indicated an invading left intrahepatic vascular tree and bile duct in the first porta hepatis; E: a large alveolar echinococcosis target in the right lobe and strong widespread adhesions with surrounding tissues made the recipient hepatectomy more difficult than in patients with other liver diseases; F: the intraoperative findings confirmed the invasion and circumvolution of the retrohepatic segment of the inferior vena cava. CT = computerized tomography, IVC = inferior vena cava.
Mentions: A 44-year-old woman with a yellowish discoloration of the skin and eyes due to advanced stage AE was transferred to our center; she came from Lhasa, the capital of the Tibetan autonomous region, which is a pasturing area in southwestern China. Three years ago, the patient was diagnosed with AE by an enhanced computerized tomography (CT); an indirect echinococcal hemagglutination test was positive, and an anti-E granulosus IgG test was positive. She refused to accept a liver resection and only took albendazole (400 mg) 3 times daily; however, the patient's status worsened due to the jaundice, abnormal coagulation, and an increasing amount and prolonged duration of menstruation. A standard laboratory biochemical analysis revealed the following results: hemoglobin: 49 g/L, total bilirubin: 269.5 μmol/L, direct bilirubin: 248.1 μmol/L, aspartate aminotransferase: 106 IU/L, alanine aminotransferase: 55 IU/L, albumin: 25 g/L, prothrombin time: 18 seconds, and international normalized ratio: 1.59. An enhanced abdominal CT indicated a large lesion in the right lobe and segment IV; the target invaded the left bile duct, and the left biliary ducts were dilated due to the obstruction (Figure 1A). A CT scan of the head and lungs found no extra-liver targets; therefore, the treatment in the hospital included a transfusion and persistent percutaneous transhepatic cholangial drainage (PTCD). After multidisciplinary discussions, with nearly 3 months of persistent drainage, the patient's liver function recovered to a normal level. Then, the ex vivo liver resection followed by autotransplantation strategy was introduced to the patient and her family.

Bottom Line: Considering the donor shortage and the drawbacks of immunosuppressive therapy, ex vivo liver resection followed by autotransplantation may be the first choice for these patients.This graft included the following regions: the bilateral great saphenous vein, part of the retrohepatic inferior vena and the middle hepatic vein with no invasion, the inferior mesenteric vein, and part of the side wall of the infrahepatic vena cava.This patient had an uneventful postoperative recovery; currently, she has been enjoying a normal life and is 12 months postoperative with no immunosuppressive therapy or AE recurrence.In conclusion, ex vivo liver resection followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting might be a useful surgical practice for advanced AE.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Liver Surgery (LJ, HO, WW); Vascular surgery (ZJ, HB, YD); ; Transplantation Center (YL), West China Hospital of Sichuan University, Chengdu, China.

ABSTRACT
Alveolar echinococcosis (AE) of the liver is a rare disease. In advanced cases of this parasitic disease, the inferior vena cava (IVC) can be invaded; in these cases, the optimal treatment is liver transplantation and replacement of the IVC. Considering the donor shortage and the drawbacks of immunosuppressive therapy, ex vivo liver resection followed by autotransplantation may be the first choice for these patients. We report the first case of advanced AE successfully treated by an ex vivo liver resection, followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting. This graft included the following regions: the bilateral great saphenous vein, part of the retrohepatic inferior vena and the middle hepatic vein with no invasion, the inferior mesenteric vein, and part of the side wall of the infrahepatic vena cava. This patient had an uneventful postoperative recovery; currently, she has been enjoying a normal life and is 12 months postoperative with no immunosuppressive therapy or AE recurrence.In conclusion, ex vivo liver resection followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting might be a useful surgical practice for advanced AE.

Show MeSH
Related in: MedlinePlus