Technique advance to avoid hepatic venous outflow obstruction in pediatric living-donor liver transplantation
Carregando...
Citações na Scopus
16
Tipo de produção
article
Data de publicação
2015
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY-BLACKWELL
Citação
PEDIATRIC TRANSPLANTATION, v.19, n.3, p.261-266, 2015
Resumo
HVOO represents a serious critical complication of pediatric living-donor liver transplantation because open surgical repair is virtually impossible. Currently, despite several technical innovations and the introduction of triangulated anastomosis for hepatic vein reconstruction, the reported incidence of HVOO is still considerable. The aim of this study was to propose a new technique for hepatic venous reconstruction that avoids the original orifice of the recipient hepatic veins. Instead, anastomosis is performed in a newly created wide longitudinal orifice in the anterior wall of the recipient inferior vena cava. A total of 210 living related-donor liver transplantations were performed using two methods for reconstruction of the hepatic vein. Group 1 included 69 patients subjected to direct anastomosis of the orifice of the graft hepatic vein and a wide orifice created in the recipient inferior vena cava by the confluence of the orifices of the right, left, and middle hepatic veins. Group 2 included 141 patients in whom the original orifices of the recipient hepatic veins were closed, the inferior vena cava was widely opened, and a long longitudinal anastomosis was performed using two lines of continuous sutures. Diagnosis of HVOO was suspected based on clinical findings and ultrasound studies and then confirmed by liver biopsy and interventional radiology examinations. Among the 69 recipients in group 1, 16 patients died due to graft problems during the postoperative period and eight of the survivors (15.1%) presented with HVOO. In group 2 (141 patients), 21 patients died, and there were no cases of HVOO. A comparison of the incidence of HVOO between groups revealed a significant difference (p=0.01). Hepatic venous reconstruction during pediatric living-donor liver transplantation should be performed using a wide longitudinal incision in the anterior wall of the recipient inferior vena cava because this technique eliminated anastomosis complications.
Palavras-chave
living-donor liver transplantation, hepatic venous obstruction, pediatric liver transplantation, donor hepatectomy, complications of liver transplantation
Referências
- Broelsch C E, 1993, Adv Surg, V26, P209
- desVilla VH, 2000, TRANSPLANTATION, V70, P1604
- Engelmann G, 2010, PEDIATR TRANSPLANT, V14, P12, DOI 10.1111/j.1399-3046.2009.01247.x
- Gibelli NEM, 2012, PEDIATR TRANSPLANT, V16, pE383, DOI 10.1111/j.1399-3046.2012.01742.x
- Heffron TG, 2010, PEDIATR TRANSPLANT, V14, P722, DOI 10.1111/j.1399-3046.2009.01259.x
- Hwang S, 2006, LIVER TRANSPLANT, V12, P920, DOI 10.1002/lt.20734
- Kanmaz T, 2014, EXP CLIN TRANSPLANT, V12, P41, DOI 10.6002/ect.2013.0016
- Kumar GK, 2010, PEDIATR SURG INT, V26, P423, DOI 10.1007/s00383-010-2564-y
- Mazariegos G V, 2000, Pediatr Transplant, V4, P322, DOI 10.1034/j.1399-3046.2000.00124.x
- Nakamura T, 2002, TRANSPLANTATION, V73, P1896, DOI 10.1097/00007890-200206270-00008
- Sakamoto S, 2013, PEDIATR TRANSPLANT, V17, pE25, DOI 10.1111/j.1399-3046.2012.01761.x
- Sakamoto S, 2010, LIVER TRANSPLANT, V16, P1207, DOI 10.1002/lt.22135
- Sommovilla J, 2014, PEDIATR TRANSPLANT, V18, P497, DOI 10.1111/petr.12277
- Tannuri U, 2005, PEDIATR TRANSPLANT, V9, P293, DOI 10.1111/j.1399-3046.2005.00306.x
- Zhong JJ, 2013, HEPATO-GASTROENTEROL, V60, P252, DOI 10.5754/hge12639