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

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.

Novel Approach via the Round Ligament in Portal Vein Embolization

“…However, the round ligament has also been found to spontaneously recanalize in patients with portal hypertension, which has likewise been proven to be useful in several other surgeries [8,9]. Clinically, the round ligament may also be effectively used in various situations such as a patch or graft for large vessel resection [9][10][11], vascular pedicle in closing a wound around the gastroduodenal artery stump to prevent bleeding after pancreatoduodenectomy [12], or reinforcement of an enteral tube to prevent peritonitis [13]. There have also been several reports of the use of the round ligament in angiography [14,15].…”