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Living donor liver transplantation with total pancreatectomy and portal vein homograft replacement in a pediatric patient with advanced pancreatoblastoma
Ann Hepatobiliary Pancreat Surg 2020 Feb;24(1):78-84
Published online February 29, 2020;  https://doi.org/10.14701/ahbps.2020.24.1.78
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 7, 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
Pancreatoblastoma is a malignant exocrine pancreatic tumor that is usually present in childhood. We herein present one case of pediatric living donor liver transplantation (LDLT) combined with spleen-preserving regional total pancreatectomy and portal vein homograft interposition in a 4-year-old boy with advanced pancreatoblastoma invading the portal and superior mesenteric veins. The size of the pancreatoblastoma was gradually reduced along systemic chemotherapy, thus we decided to perform surgery to remove it completely. A cold-stored fresh iliac vein homograft was prepared. Initially, a spleen-preserving distal pancreatectomy was performed. Thereafter, a completion regional total pancreatectomy was performed under superior mesenteric vein-vena cava bypass. A left liver graft from his mother was implanted according to the standardized procedures with portal vein interposition. This patient recovered uneventfully and is currently undergoing scheduled adjuvant chemotherapy. To our knowledge, this is the world-second case of pediatric LDLT for advanced pancreatoblastoma. Availability of fresh vein homografts is helpful to expand the indication of pediatric LDLT.
Keywords : Homograft; Pancreatectomy; Pediatric transplantation; Pancreatoblastoma

 

February 2020, 24 (1)