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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: The reconstructed retrohepatic inferior vena was perfused; B: the fluent drainage of the portal vein and hepatic artery.
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Figure 4: A: The reconstructed retrohepatic inferior vena was perfused; B: the fluent drainage of the portal vein and hepatic artery.

Mentions: Intraoperative confirmation of the invasion to the IVC forced us to perform an IVC resection in the liver and then replace part of the resected IVC with a combination of autogenous vein grafting (Figure 1F). As soon as the liver was completely resected, the liver graft was perfused with 4000 mL of 4°C University of Wisconsin solution via the portal vein. Then, an intraoperative ultrasound sonography was used to make the incision and to guide the parenchyma transaction using an ultrasound knife. The procedure for the parenchyma transaction was similar to liver graft harvesting from living donors, which has been introduced in our previous studies.6,7 The total size of the resected left liver graft was 360 g, and the graft-to-recipient weight ratio (GRWR) was 0.72%. Concurrently, the resected part of the IVC was reconstructed with an artificial blood vessel, and then an end-to-side anastomosis was made between the portal vein and the artificial blood vessel for the portacaval shunt (Figure 2). Our third group (vascular surgeon) tried their best to reconstruct the retrohepatic segment of the IVC using the following autogenous veins: 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. Together, these veins made a vena cava vessel that was 5 cm long and 3 cm in diameter, which was then implanted into the patient with end-to-end anastomosis (Figure 3A–H). There are triangular openings in the upper anatomy, and the main reason was a lack of autogenous veins; this opening can also be used to reconstruct the anatomy with the left hepatic vein. The left hepatic vein was directly anastomosed end to side to the suprahepatic IVC with the triangular opening. Venous and arterial reconstructions were performed with the standard method that was mentioned previously regarding the left lobe living donor liver transplantation; the left portal vein was sutured end to end to the main portal vein. The proper hepatic artery was reconnected by end-to-end anastomosis to its left branch (Figure 4A and B), and the left hepatic biliary duct was then drained by a Roux-en-Y hepaticojejunostomy.


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: The reconstructed retrohepatic inferior vena was perfused; B: the fluent drainage of the portal vein and hepatic artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: A: The reconstructed retrohepatic inferior vena was perfused; B: the fluent drainage of the portal vein and hepatic artery.
Mentions: Intraoperative confirmation of the invasion to the IVC forced us to perform an IVC resection in the liver and then replace part of the resected IVC with a combination of autogenous vein grafting (Figure 1F). As soon as the liver was completely resected, the liver graft was perfused with 4000 mL of 4°C University of Wisconsin solution via the portal vein. Then, an intraoperative ultrasound sonography was used to make the incision and to guide the parenchyma transaction using an ultrasound knife. The procedure for the parenchyma transaction was similar to liver graft harvesting from living donors, which has been introduced in our previous studies.6,7 The total size of the resected left liver graft was 360 g, and the graft-to-recipient weight ratio (GRWR) was 0.72%. Concurrently, the resected part of the IVC was reconstructed with an artificial blood vessel, and then an end-to-side anastomosis was made between the portal vein and the artificial blood vessel for the portacaval shunt (Figure 2). Our third group (vascular surgeon) tried their best to reconstruct the retrohepatic segment of the IVC using the following autogenous veins: 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. Together, these veins made a vena cava vessel that was 5 cm long and 3 cm in diameter, which was then implanted into the patient with end-to-end anastomosis (Figure 3A–H). There are triangular openings in the upper anatomy, and the main reason was a lack of autogenous veins; this opening can also be used to reconstruct the anatomy with the left hepatic vein. The left hepatic vein was directly anastomosed end to side to the suprahepatic IVC with the triangular opening. Venous and arterial reconstructions were performed with the standard method that was mentioned previously regarding the left lobe living donor liver transplantation; the left portal vein was sutured end to end to the main portal vein. The proper hepatic artery was reconnected by end-to-end anastomosis to its left branch (Figure 4A and B), and the left hepatic biliary duct was then drained by a Roux-en-Y hepaticojejunostomy.

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