Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation

Marwan, Ibrahim; Fawzy, Ahmed Tarek I.; Egawa, Hiroto; Inomata, Yukihiro; Üemoto, Shinji; Asonuma, Katsuhiro; Kiuchi, Tetsuya; Hayashi, Michihiro; Fujita, Shiro; Ogura, Yasuhiro; Tanaka, Kōichi

doi:10.1016/s0039-6060(99)70236-9

Cited by 60 publications

(36 citation statements)

References 7 publications

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“…Accordingly, a 5‐cm segment of the inferior mesenteric vein was harvested from the living donor, after completion of the donor left lobectomy. A portoplasty using a latero‐lateral anastomosis between the donor inferior mesenteric vein and the recipient fibrous PV was constructed before conventional implantation of the left PV of the liver lobe allograft on this portoplasty (3). Unfortunately, intra‐operative echo‐Doppler ultrasound performed at the completion of the arterial revascularization found absent portal flow probably caused by kinking and relative stenosis of the PV anastomosis and portoplasty, complicated by intra‐operative thrombosis.…”

Section: Case Reportmentioning

confidence: 99%

Meso‐Rex shunt for immediate portal revascularization in pediatric liver transplantation: First report

Rivera

Fusaro

Magnée

et al. 2011

Pediatric Transplantation

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We describe the case of a 13-month-old girl transplanted for biliary atresia with PV hypoplasia. She received the left liver lobe of her mother and presented intraoperative portal thrombosis. Because of technical reasons, the opportunity to have conventional PV reconstruction using the donor left PV stump was lost. Immediate conversion to a meso-Rex shunt, using the recipient jugular vein as a bridge between the superior mesenteric vein and the graft Rex recessus, allowed excellent portal revascularization of the transplant. We suggest that synchronous meso-Rex shunt may constitute a valid alternative to truncal PV anastomosis during pediatric LT.

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Section: Case Reportmentioning

confidence: 99%

Meso‐Rex shunt for immediate portal revascularization in pediatric liver transplantation: First report

Rivera

Fusaro

Magnée

et al. 2011

Pediatric Transplantation

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“…However, advances in and the maturity of this technique have also brought a new problem in that the donor supply cannot meet increasing recipient demand, especially for children and small adult recipients. To avoid withdrawing relatively large livers from the adult donor pool, RSLT has been developed to maximize the use of donor organs . RSLT involves the transplantation of a lobe or left lateral segment from a cadaveric donor liver .…”

Section: Discussionmentioning

confidence: 99%

Protective role of normothermic machine perfusion during reduced‐size liver transplantation in pigs

Zhang¹,

Gao

Shi

et al. 2016

Liver Transpl

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The purpose of this study is to explore whether normothermic machine perfusion (NMP) preservation is superior to cold preservation during reduced-size liver transplantation (RSLT) in pigs. Twenty-four healthy Ba-Ma mini pigs were used (aged >13 months; weight 25-35 kg; regardless of sex). The animals were randomized into 2 groups. In group A (NMP), donor livers were harvested without warm ischemia time and heartbeats and then were connected to the NMP system to reduce the livers' size under the normothermic condition. In group B (University of Wisconsin [UW] solution), donor livers were harvested without warm ischemia time and heartbeats after being perfused by UW solution and were then preserved in 08C-48C UW solution to reduce the livers' size under cold conditions. After that, liver transplantation without venovenous bypass was performed. General RSLT information of the pigs from the 2 groups was recorded; the serological indices were measured; and routine pathological examination of liver tissue was observed. A significant difference was observed in the intraoperative bleeding between the 2 groups (P < 0.05), whereas no significant difference was found in the other indices (all P > 0.05). Significant differences of alanine aminotransferase levels, aspartate aminotransferase levels, and lactate dehydrogenase levels between the 2 groups were observed between postoperative days 3 and 5 (P < 0.05). Significant differences of lactic acid levels between the 2 groups were observed between postoperative days 2 and 5 (P < 0.05). Compared with the cold preservation group, the liver tissues of the NMP preservation group only rarely experienced liver cell necrosis and maintained integrities in the hepatic sinusoid spaces and endothelial cells. In conclusion, NMP preservation is superior to cold preservation during RSLT in pigs.Liver Transplantation 22 968-978 2016 AASLD. Liver transplantation is an effective therapeutic approach for end-stage liver disease. However, although this technique is mature and well recognized, an increasing number of patients requiring liver transplantation die on the waiting list. It is estimated that the overall fatality rate of patients on the waiting list is over 10%, and of this rate, more than 20% are children recipients. (1,2) The main reason is that there would never be enough pediatric donors to meet the needs of children in whom biliary atresia was the main indication for liver transplantation, (3) and a discrepancy in size between a small recipient and a large liver graft sometimes makes a reduction of the graft necessary to avoid difficulty in abdominal closure and respiratory impairment. (4) To solve this problem, in 1969, Gans (5) performed heterotopic partial liver transplants, which was reported by Fortner et al. (6) in 1979. Bismuth and Houssin (7) are credited with the first orthotopic partial liver transplant in 1984, when they transplanted the left hemiliver with the inferior vena cava in the standard manner, from a 75-kg adult to a 10-year-old 26-kg recipient. This method...

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“…To avoid withdrawing relatively large livers from the adult donor pool, the split liver technique has emerged [1].This technique was first described by Bismuth and Houssin in 1984 [2]. Couinaud's anatomical classification permits the creation of partial liver allografts from either deceased or living donors.…”

Section: Reduced-size Liver Transplantationmentioning

confidence: 99%

Partial liver transplantation

Gong

Chen

2011

Front. Med.

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Partial liver transplantation, including reducedsize liver transplantation, split liver transplantation, and living donor liver transplantation, has been developed with several innovative techniques because of donor shortage. Reduced-size liver transplantation is based on Couinaud's anatomical classification, benefiting children and small adult recipients but failing to relieve the overall donor shortage. Split liver transplantation provides chances to two or even more recipients when only one liver graft is available. The splitting technique must follow stricter anatomical and physiological criteria either ex situ or in situ to ensure long-term quality. The first and most important issue involving living donor liver transplantation is donor safety. Before surgery, a series of donor evaluations-including anatomical, liver volume, and liver function evaluations-is indispensable, followed by ethnic agreement. At different recipient conditions, auxiliary liver transplantation and auxiliary partial orthotopic liver transplantation, which employ piggyback techniques, are good alternatives. Partial liver transplantation enriches the practice and knowledge of the transplant society.

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Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation

Cited by 60 publications

References 7 publications

Meso‐Rex shunt for immediate portal revascularization in pediatric liver transplantation: First report

Meso‐Rex shunt for immediate portal revascularization in pediatric liver transplantation: First report

Protective role of normothermic machine perfusion during reduced‐size liver transplantation in pigs

Partial liver transplantation

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