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KMID : 1143920200240010072
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Annals of Hepato-Biliary-Pancreatic Surgery
2020 Volume.24 No. 1 p.72 ~ p.77
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Living-donor liver transplantation with inferior vena cava replacement in an infant recipient with advanced hepatoblastoma
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Namgoong Jung-Man
Hwang Shin
Oh Seak-Hee
Kim Kyung-Mo
Park Gil-Chun
Ahn Chul-Soo
Kwon Hyun-Hee
Cho Yu-Jeong
Kwon Yong-Jae
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Abstract
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Replacement of the inferior vena cava (IVC) after concurrent resection of hepatoblastoma-containing liver and retrohepatic IVC is regarded as a feasible option for pediatric living-donor liver transplantation (LDLT). This technique makes the extent of resection of LDLT comparable to that of deceased-donor liver transplantation (DDLT). We present one case of pediatric LDLT with IVC homograft replacement for advanced hepatoblastoma. The patient was a 10-kg 18-month-old girl suffering from large multiple hepatoblastomas, which were partially regressed by neoadjuvant chemotherapy. Because the tumors had invaded the retrohepatic IVC, there was a high risk of residual tumor cells at the IVC if it was preserved. Thus, we decided to replace the IVC during the LDLT operation. After a cold-stored fresh iliac vein homograft was prepared, we performed LDLT using her mother’s left lateral section liver graft. A 4-cm-long common iliac vein homograft was attached to the liver graft at the back table. The left lateral-section graft with IVC attachment was implanted using the standard procedures like those of DDLT. We also did portal vein graft interposition. The patient recovered uneventfully and has been undergoing scheduled adjuvant chemotherapy to date. This is our second case of IVC homograft replacement for pediatric LDLT. In pediatric recipients, various vein homografts, such as iliac vein, IVC, and other large veins, can be used depending on the body size of the recipient and availability of vein homografts.
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KEYWORD
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Interposition, Venoplasty, Pediatric transplantation
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