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Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

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ABSTRACT

Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor’s opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient’s HV and the donor’s opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology.

No MeSH data available.


Abdominal enhanced computed tomography on post-operative day 82. The radiological patency of the donor’s opened round ligament and the hepatic vein was confirmed (A, B, C, D). RHV: Right hepatic vein; IRHV: Inferior right hepatic vein.
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Figure 2: Abdominal enhanced computed tomography on post-operative day 82. The radiological patency of the donor’s opened round ligament and the hepatic vein was confirmed (A, B, C, D). RHV: Right hepatic vein; IRHV: Inferior right hepatic vein.

Mentions: There were no post-transplant complications involving the HVs, and the radiological patency between the opened round ligament and the HV was confirmed on POD 82 (Figure 2). The HV anastomotic site had no stenosis or thrombus on an autopsy (Figure 3A and B). The patency and continuity between the donor’s opened round ligament and the HV were adequate on pathological examination. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive, a finding also observed in the graft HV (Figure 3C and D).


Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report
Abdominal enhanced computed tomography on post-operative day 82. The radiological patency of the donor’s opened round ligament and the hepatic vein was confirmed (A, B, C, D). RHV: Right hepatic vein; IRHV: Inferior right hepatic vein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016385&req=5

Figure 2: Abdominal enhanced computed tomography on post-operative day 82. The radiological patency of the donor’s opened round ligament and the hepatic vein was confirmed (A, B, C, D). RHV: Right hepatic vein; IRHV: Inferior right hepatic vein.
Mentions: There were no post-transplant complications involving the HVs, and the radiological patency between the opened round ligament and the HV was confirmed on POD 82 (Figure 2). The HV anastomotic site had no stenosis or thrombus on an autopsy (Figure 3A and B). The patency and continuity between the donor’s opened round ligament and the HV were adequate on pathological examination. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive, a finding also observed in the graft HV (Figure 3C and D).

View Article: PubMed Central - PubMed

ABSTRACT

Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor’s opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient’s HV and the donor’s opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology.

No MeSH data available.