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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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An enhanced CT scan at 14 days after the operation indicated a patency of the IVC and no obstruction. CT = computerized tomography, IVC = inferior vena cava.
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Figure 6: An enhanced CT scan at 14 days after the operation indicated a patency of the IVC and no obstruction. CT = computerized tomography, IVC = inferior vena cava.

Mentions: The patient was transferred to the liver transplantation intensive care unit (ICU) and was closely observed and treated. The liver function recovered to normal within 15 days (Figure 5 with no severe complications (grade III or IV according to the Clavien classification system), and renal function was not impaired during the close monitoring. A low-molecular-weight heparin sodium anticoagulation solution (0.6 mL, bid, ih) was used from 2 days after surgery until discharge with no signs of postoperative bleeding, and the patient was given warfarin (2.5 mg, qd, po) for the last 3 months. An ultrasound was used to monitor the cleanliness of the anastomosis of the vessels or the presence of seroperitoneum. An enhanced CT scan on day 14 after the operation indicated the patency of the IVC and no obstruction (Figure 6). There was no requirement for antirejection drugs, such as tacrolimus, mycophenolate mofetil, or prednisone, and no albendazole was required. After 5 months of close follow-up, the patient had recovered very well and had returned to normal life and work 3 months after the surgery.


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)

An enhanced CT scan at 14 days after the operation indicated a patency of the IVC and no obstruction. 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 6: An enhanced CT scan at 14 days after the operation indicated a patency of the IVC and no obstruction. CT = computerized tomography, IVC = inferior vena cava.
Mentions: The patient was transferred to the liver transplantation intensive care unit (ICU) and was closely observed and treated. The liver function recovered to normal within 15 days (Figure 5 with no severe complications (grade III or IV according to the Clavien classification system), and renal function was not impaired during the close monitoring. A low-molecular-weight heparin sodium anticoagulation solution (0.6 mL, bid, ih) was used from 2 days after surgery until discharge with no signs of postoperative bleeding, and the patient was given warfarin (2.5 mg, qd, po) for the last 3 months. An ultrasound was used to monitor the cleanliness of the anastomosis of the vessels or the presence of seroperitoneum. An enhanced CT scan on day 14 after the operation indicated the patency of the IVC and no obstruction (Figure 6). There was no requirement for antirejection drugs, such as tacrolimus, mycophenolate mofetil, or prednisone, and no albendazole was required. After 5 months of close follow-up, the patient had recovered very well and had returned to normal life and work 3 months after the surgery.

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