Alternatives for vascular reconstruction in pediatric living donor liver transplantation

Abstract

Many publications discuss the various strategies for vascular reconstruction (VR) in pediatric LDLT. Having knowledge of alternative techniques is helpful in planning transplants. This article presents three case reports that illustrate some of the alternative techniques for HV, PV, and HA reconstruction in pediatric LDLT. It also reviews the available alternative strategies reported for VR in pediatric LDLT. In the first case, a 13-month-old girl presented a PRETEXT III HB with invasion of the retrohepatic vena cava. An LLS graft HV was anastomosed to a DD iliac vein graft and subsequently implanted in a "standard" fashion in the recipient. In the second case, a 44-month-old boy presented with multifocal HB and portomesenteric thrombosis and the portal inflow was done through a renoportal anastomosis. In the third case, a 22-month-old child with a failed Kasai procedure had extensive HA thrombosis. The HA reconstruction was performed with an interposition of the recipient's IMV graft. The use of alternative techniques for VR in pediatric LDLT is paramount to the success of such a complex procedure. Imaging studies can help transplant surgeons outline surgical strategies and define the best technique to be used in each case.

Optimizing hepatic venous outflow reconstruction for hepatic vein stenosis with indwelling stent in living donor liver retransplantation

“…Caval replacement would have been the best procedure for the patient of the present case if a deceased donor graft had been available. Caval replacement using a vascular graft, such as a cryopreserved or synthetic graft, may be an alternative in the setting of LDLT; however, there is a certain risk of thrombus and infection with the use of any type of vascular graft . Moreover, the long‐term patency of vascular grafts is still unknown.…”

“…Caval replacement using a vascular graft, such as a cryopreserved or synthetic graft, may be an alternative in the setting of LDLT; however, there is a certain risk of thrombus and infection with the use of any type of vascular graft. 7,8 Moreover, the long-term patency of vascular grafts is still unknown. Wang et al reported on outflow reconstruction of the right anterior sector in a right liver graft with a cryopreserved vascular graft and noted that the patency rates at 2 weeks and 2 years after LDLT were 90%-94% and 54.5%-61.7%, respectively.…”

Renoportal Anastomosis in Left Lateral Lobe Living Donor Liver Transplantation: A Pediatric Case

“…Two recipients were much older than our patient, and either an extended left lobe graft or a left lobe graft was used in those patients [ 2 , 7 ]. One recipient received a left lateral lobe graft, but he was much older than our patient [ 8 ]. To our knowledge, our patient was the youngest case of RPA in pediatric LDLT with a left lateral lobe graft.…”