Klinische Erfahrung mit einer atypischen Hohlvenenanastomose bei einem Fall von orthotoper Lebertransplantation

Abstract

The two main indications for liver grafting are primary malignancy and parenchymatous liver disease. In both cases orthotopic transplantation remains the preferred technique. Since graft rejection was considered not to be the main problem in clinical liver transplantation, recent improved survival rates were reported to be due to a more aggressive diagnostic management and consequent treatment of postoperative complications nonrelated to graft rejection. Because of the limited number of organs available for organ grafting sometimes technical modifications may become necessary. This was the case in a 40-year old male patient suffering from primary malignant hepatoma. The donor was a child, and during operation a great difference between organ size and length and diameter of the hepatic vessels became evident. Orthotopic transplantation was performed using an unusual method of caval vein anastomosis. Initially the patient did very well, but later on liver function deteriorated and the patient died in the eighth postoperative week because of hepatic artery thrombosis. The autopsy showed that all other vascular anastomosis were patent and no signs of portal hypertension were evident. The surgical technique used in this case is described in detail and some interesting aspects are discussed.

A new technique of hepatic vein reconstruction in partial liver transplantation

“…To overcome the limited resources of pediatric organs, we have had to adjust our present concept, which is primarily directed at reduction of adult donor livers, usually necessitating 70%-80% hepatectomy ("trisegmentectomy") before transplantation into pediatric recipients. Since this raises a variety of important technical problems related to The development of our new technique is based on the fact that recipient hepatectomy can safely be performed without removal of the inferior caval vein [6,16,181. Following ex vivo right "trisegmentectomy," including removal of segment I and the donor IVC, venous drainage of the bisegmental graft (segments 11 and 111) is easily achieved by endto-side anastomosis between the left hepatic vein and the inferior vena cava.…”

Partial Orthotopic Liver Transplantation in Rats

“…A possi ble solution is the segmental transplantation of adult liver grafts in children [1][2][3][4] with the inferior vena cava remaining in situ [5]. This makes it possible to use the remaining part of the graft containing the inferior vena cava for transplantation in adult recipients ['splitting transplantation' according to 2], An inherent disadvantage of this method is, however, that the adult recipient is provided with too small a graft on a body weight basis ('small-for-size' situation) [6],The aim of the present study was to develop a partial orthotopic liver trans plantation technique (POLT) in rats which is comparable with the 'splitting transplanta tion' in adult humans.…”