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Living-donor liver transplantation with inferior vena cava replacement in an infant recipient with advanced hepatoblastoma
Ann Hepatobiliary Pancreat Surg 2020 Feb;24(1):72-7
Published online February 29, 2020;  https://doi.org/10.14701/ahbps.2020.24.1.72
Copyright © 2020 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Jung-Man Namgoong1, Shin Hwang2, Seak Hee Oh3, Kyung Mo Kim3, Gil-Chun Park2, Chul-Soo Ahn2, Hyunhee Kwon1, Yu Jeong Cho1, and Yong Jae Kwon1

1Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 2Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 3Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Received January 30, 2020; Revised February 3, 2020; Accepted February 9, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
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.
Keywords : Interposition; Venoplasty; Pediatric transplantation