Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

Kanazawa, Hideko; Sakamoto, Seisuke; Fukuda, Akira; Shigeta, Takanobu; Loh, Dale Ser Kheng Lincoln; Kakiuchi, Toshihiko; Karaki, Chiaki; Miyazaki, Osamu; Nosaka, Syunsuke; Nakazawa, Atsuko; Kasahara, Mureo

doi:10.1016/j.jpedsurg.2011.09.036

Cited by 34 publications

(33 citation statements)

References 12 publications

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“…Fourthly, the final positioning of the venous reconstruction and of the LLS graft at the closing of the abdomen may be difficult, and there is a risk of compression or a kinking of the vein. PV hypoplasia and/or a PDP have significantly been found to be associated with a higher risk of complications or decreased outcomes by many authors, (3,4) and the problem of positioning the vein and the graft was highlighted by Kato et al, (4) who described "a flip" of the graft as a possible solution. The meso-Rex reconstruction mode has been reported in only a few patients, wherein it was implemented as rescue revascularization for an immediate thrombosis of the PV at transplantation or early in the postoperative course.…”

Section: Discussionmentioning

confidence: 99%

Preduodenal Portal Vein Reconstruction at Liver Transplantation: The Challenges and a Solution

Francesco¹,

Caruso

Bonsignore³

et al. 2019

Liver Transpl

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Section: Discussionmentioning

confidence: 99%

Preduodenal Portal Vein Reconstruction at Liver Transplantation: The Challenges and a Solution

Francesco¹,

Caruso

Bonsignore³

et al. 2019

Liver Transpl

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“…Furthermore, this technique can be combined with a portal reconstruction using interposition vein graft when the PV is sclerotic and had undergone atrophic change in recipients; for example, in patients with biliary atresia, direct anastomosis of PV cannot be performed due to an insufficient front flow because of some collateral vessels derived from the main PV. We have applied the “pullout” technique in such cases and achieved positive outcome .…”

Section: Discussionmentioning

confidence: 99%

Technical refinement in living‐donor liver transplantation for hepatoblastoma with main portal vein tumor thrombosis – a pullout technique

Kanazawa

Sakamoto

Matsunami

et al. 2014

Pediatric Transplantation

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We present a case of a two-yr-old boy diagnosed with HBT with complete main PVTT. HBT was located in the bilateral lobe with PVTT involving the confluence of the SMV and the SpV. Cisplatin-based neoadjuvant chemotherapy was delivered; main tumor shrank and AFP levels decreased to below one hundredth. However, PVTT remained in the bilateral portal branches to the main trunk of PV. We describe the technical details of the portal venous tumor thrombectomy that was succeeded by a LDLT. The patient remained healthy 2.5 yr after LDLT, showing good patency of the PV with no evidence of recurrence of tumor.

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“…In living donors with suspected bile duct anomalies in the CT scan, the biliary tree is investigated further with a magnetic resonance cholangiopancreatography. Routine immunosuppression and anticoagulation for intraoperative thrombosis have already been described …”

Section: Methodsmentioning

confidence: 99%

“…Routine immunosuppression and anticoagulation for intraoperative thrombosis have already been described. (5,6) The study was approved by the ethics committee of the National Center for Child Health and Development, and it was conducted in accordance with the Declaration of Helsinki (2008). No organs from executed prisoners were used.…”

Section: Our Patient Seriesmentioning

confidence: 99%

Technical Considerations in Liver Transplantation for Biliary Atresia With Situs Inversus

et al. 2019

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In liver transplantation (LT) for biliary atresia (BA) with situs inversus (SI), the surgical procedure is technically challenging due to multiple anatomical variations. We evaluated the surgical procedures and the outcomes in our patients and in the previously reported patients undergoing LT for BA with SI. Between November 2005 and October 2018, 235 children underwent LT with an overall 10‐year graft survival of 94.7%. Of these, 6 (2.6%) patients received LT for BA with SI. Living donor liver transplantation (LDLT) was applied in all patients. Vascular anomalies at our center included the absence of the inferior vena cava (IVC; n = 5), a preduodenal portal vein (PV; n = 4), and an aberrant hepatic artery (HA; n = 1). Hepatic vein (HV) outflow obstruction occurred in 1 patient with an absent IVC and necessitated repositioning of the graft immediately after LDLT. PV stenosis occurred in 1 patient with a preduodenal PV at 5 months after LDLT. The overall survival of our patients was 80.0% at 3 years. In the literature, 49 patients with LT for BA with SI were reviewed. The survival rate was 91.8%, and the vascular complications included HV outflow obstruction (2.0%), PV complications (10.2%), and HA thrombosis (4.1%). All PV complications occurred in LDLT patients with a preduodenal PV (5/23; 21.7%). In conclusion, the detailed assessment of the surgical procedures and the systematic literature review demonstrated excellent outcomes after LT for BA with SI. Liver recipients with a preduodenal PV are exposed to a higher risk for vascular complications after a very challenging LT procedure with overall good outcomes.

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Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

Cited by 34 publications

References 12 publications

Preduodenal Portal Vein Reconstruction at Liver Transplantation: The Challenges and a Solution

Preduodenal Portal Vein Reconstruction at Liver Transplantation: The Challenges and a Solution

Technical refinement in living‐donor liver transplantation for hepatoblastoma with main portal vein tumor thrombosis – a pullout technique

Technical Considerations in Liver Transplantation for Biliary Atresia With Situs Inversus

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