Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use

Enne, Marcelo; Pacheco-Moreira, L.F.; Balbi, E.; Cerqueira, Alexandre; Alves, Juliano; Valladares, Marcia A.; Santalucia, Giuseppe; Martinho, José Manoel

doi:10.1111/j.1399-3046.2009.01219.x

Cited by 13 publications

(10 citation statements)

References 28 publications

(38 reference statements)

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“…Although application of the microsurgical technique in LDLT reduced the arterial complication rates, the HA anastomosis under an operating microscope is always time consuming, and a long learning curve is required. A continuous end‐to‐end suturing technique using magnifying loupes appears more feasible and yields similar or even better results . This large‐scale experience of HA reconstruction under magnifying loupes in 741 consecutive LDLT recipients shows the safety and feasibility of the procedure.…”

Section: Discussionmentioning

confidence: 80%

“…Two of the patients who developed acute thrombosis leading to no flow were subjected to thrombus removal using a Fogarty catheter, and a revision of the HA anastomosis was initially attempted. Supraceliac aortohepatic anastomosis was done in 11 patients using the left great saphenous vein, whereas RGEA was used as an alternative to the recipient HA in 3 patients (1 patient in era 1 and 2 patients in era 2). One recipient with a supraceliac aortic conduit developed a pseudoaneurysm of the saphenous conduit from the aortic side on the second postoperative day and developed an intra‐abdominal hematoma.…”

Section: Resultsmentioning

confidence: 99%

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Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Thorat

Jeng

et al. 2017

Liver Transpl

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The reconstruction of the hepatic artery (HA) is the most complex step in living donor liver transplantation (LDLT) because of the smaller diameter of the artery and the increased risk of HA-related complications. Because of the smaller diameter of the HA, many centers use a microsurgical technique with interrupted sutures for arterial anastomosis. The aim of our study was to retrospectively investigate the outcomes after HA reconstruction performed under magnifying loupes using the "parachute technique." From August 1, 2002 to August 31, 2016, LDLT was performed in 766 recipients. HA reconstruction for the initial 25 LDLT surgeries was performed using a microsurgery technique (era 1). From May 2007 until the end date, HA reconstruction was performed in 741 recipients by a "parachute technique" under surgical loupes (era 2). HA reconstruction was performed using surgical loupes in 737 adults (male:female, 526:211) and 4 pediatric patients (male:female, 3:1). The average diameter of the donor graft HA was 2.8 mm (range, 1-6.5 mm). The most notable factor in this era was the quick HA anastomosis procedure with a mean time of 10 ± 5 minutes (range, 5-30 minutes). In era 2, 9 (1.21%) patients developed hepatic artery thrombosis (HAT), whereas 2 patients developed nonthrombotic HA-related complications. Extra-anatomic HA reconstruction was performed in 14 patients due to either primary HA anastomosis failure or a poor caliber recipient HA. The use of magnifying surgical loupes to perform HA reconstruction is safe, feasible, and yields a low incidence of HA-related complications. The "parachute technique" for HA reconstruction can achieve a speedy reconstruction without increasing the risk of HAT. Liver Transplantation 23 887-898 2017 AASLD.

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Section: Discussionmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Thorat

Jeng

et al. 2017

Liver Transpl

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“…Sixteen studies from a pool of sixty-two were selected (6,7,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(23)(24)(25)44) (Figure 1 and Table 1). Six articles (21,22,(26)(27)(28)45) were excluded to avoid repetition as more updated publications from the same institutions were identified.…”

Section: Resultsmentioning

confidence: 99%

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Gavriilidis¹,

Hidalgo²

2022

Hepatobiliary Surg Nutr

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Importance: In paediatric liver transplantation, excessive graft volume can represent an issue when the graft-recipient-weight-ratio (GRWR) is significantly disproportionate. The traditional left lateral sector (LLS) might too big in small infants and other alternatives are required, such as Monosegmental or Reduced (including Hyper-reduced) grafts. However, replicating the excellent results achieved with full LLS is challenging given (I) the technical complexity generating these modified grafts and (II) the need to overcome the large-for-size scenario in small infants.Objective: An appraisal of the existing experience and results of monosegmental, reduced or hyper-reduced left lateral sector grafts was performed.Data sources: A systematic search of the literature was conducted in Embase, google scholar, Cochrane library, and PubMed.Study selection: Sixteen studies from a pool of sixty-two were selected. Results: After scrutiny of the available literature, sixteen studies were included with 330 patients, transplanted with monosegmental and reduced/hyper-reduced left lateral sectors grafts. There were 10 re-grafts (6 of them <90 days). Overall, median recipient's age and weight were 7 months (5 days-22 months) and 5.8 kg (2.6-8) respectively.Median graft weight was 209 grams and median GRWR was 3.5% (range, 2.7-5.6). 120 out of the 330 pLT were monosegmental (37%) producing a smaller graft (median of 164 grams) and accordingly a lower GRWR (median 3.2%) compared to reduced LLS. Hepatic artery and portal vein thrombosis overall incidence were 1.5% and 4.2%. With a median follow-up of 39 months (range, 6-87), the overall graft and patient survival were 84% (285/340) and 89% (295/330).Conclusions: Monosegmental and Reduced/Hyper-reduced LLS grafts provide access to liver transplantation for very small recipients with excellent results, comparable to the standard LLS.

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“…Microvascular anastomosis with the use of a surgical microscope in pediatric LDLT is paramount to HA reconstruction , but good results can also be achieved with other techniques . There is consensus that in LDLT, the HA dissection in the recipient must be high in the liver hilum to provide a higher number of arterial options for reconstruction, especially when microsurgery is the standard technique.…”

Section: Discussionmentioning

confidence: 99%

Alternatives for vascular reconstruction in pediatric living donor liver transplantation

Neto

Fonseca

Cândido

et al. 2016

Pediatric Transplantation

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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.

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Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use

Cited by 13 publications

References 28 publications

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Alternatives for vascular reconstruction in pediatric living donor liver transplantation

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