Living-Related Liver Transplantation and Vena Cava Reconstruction After Total Hepatectomy Including the Vena Cava for Hepatoblastoma1

Abstract

Total hepatectomy including the retrohepatic IVC is not a technical obstacle to LRLT. Therefore, scheduled surgery, at the best time after chemotherapy, can be considered in all patients with otherwise irresectable HBs.

Living Donor Liver Transplantation With Vena Cava Replacement

“…However, IVC replacement becomes necessary in the presence of advanced fibrosis, widespread thrombosis, prior use of a metal stent, or deterioration of the vascular wall structure. Additionally, if a patient has no pre-existing paravertebral circulation to the azygos system, a sudden interruption of the caval flow may have deleterious effects after transplantation, especially on renal function, and a reconstruction of the retrohepatic IVC seems advisable [4]. To our knowledge, this case series is the largest series in the literature; the other options were not possible, therefore LDLT with resection and replacement of retrohepatic inferior vena cava was performed in all patients.…”

Untitled

“…Autologous, allogenic, and even artificial synthetic grafts have been used for vessel reconstruction in liver transplant procedures with encouraging results. 6,7,9,10 In reports of LDLT with total hepatectomy including the retrohepatic vena cava with reconstruction of the IVC for malignancy have also been published, [5][6][7][8][9][10][11][12] some tumors even exceeded Milan criteria. 6 In summary, we report the first case of caval replacement in LDLT in Saudi Arabia, showing 3-year survival at follow-up and at least 2 years of disease-free survival ( Figure 1B).…”

“…[1][2][3][4] Reports of living-donor liver transplant (LDLT) with total hepatectomy, including the retrohepatic vena cava and reconstruction of the IVC, have also been published. [5][6][7][8][9][10][11][12] For patients with hepatocellular carcinoma (HCC) combined with cirrhosis, a liver transplant remains the best option for long-term survival. However, in the Model for End-Stage Liver Disease era, applying stringent criteria like Milan in light of the scarcity of organs exerts pressure on decision-making even before these patients are listed.…”

Living-Donor Liver Transplant With an Interposition Graft of the Inferior Vena Cava for Hepatocellular Carcinoma: Beyond the Milan Criteria and Within the UCSF Criteria

“…Therefore, removal of the entire liver, combined with retrohepatic IVC, was needed to minimize mobilization and maximize oncologic safety. The IVC resection and reconstruction, combined with liver transplant for hepatic malignancy or extensive retroperitoneal tumor involving the IVC [3][4][5][6] or for a patient in an urgent state, [7][8][9] have been performed in select cases. In these cases, an autologous iliac vein, a deceased-donor vena cava or a prosthetic graft (including Dacron and polytetrafluoroethylene) have been used for reconstruction of the IVC.…”