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Pediatric living donor liver transplantation with homograft replacement of retrohepatic inferior vena cava for advanced hepatoblastoma
Ann Hepatobiliary Pancreat Surg 2019 May;23(2):178-82
Published online May 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.2.178
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Jung-Man Namgoong1,*, Jin-Uk Choi1,*, Shin Hwang1, Suk-Hee Oh2, Gil-Chun Park1

Departments of 1Surgery and 2Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Received April 9, 2019; Revised April 12, 2019; Accepted April 13, 2019.
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 retrohepatic inferior vena cava (IVC) after concurrent resection of IVC and hepatocellular carcinoma-containing liver is settled as a feasible living donor liver transplantation (LDLT) technique to cope with tumors around the IVC. This technique makes LDLT comparable to deceased-donor liver transplantation (DDLT). In the current Korean setting, the common substitute for IVC is a Dacron graft for adult recipients. In contrast, such a synthetic graft cannot be used for pediatric patients because of ongoing growth. We present one pediatric LDLT case with IVC homograft replacement for advanced hepatoblastoma. The patient was a 8 year-old boy suffering from large multiple hepatoblastomas. The tumors encroached the retrohepatic IVC. Thus there was high risk of residual tumor cells at the IVC, if it was preserved. Thus, we decided to replace IVC at the time of LDLT. After waiting for >1 month, we finally obtained cold-stored IVC homograft and LDLT was performed with the mother’s left liver. A 4 cm-long IVC allograft was anastomosed at the back table. The left liver graft with IVC interposition was implanted along standard procedure similar to DDLT. The patient recovered uneventfully and is undergoing scheduled adjuvant chemotherapy. We have performed >20 cases of IVC replacement in adult recipients with hepatocellular carcinoma or Budd-Chiari syndrome, but all vessel substitutes were synthetic, because sizable IVC homograft is unavailable. In pediatric recipients, various vein homografts such as iliac vein, IVC and other large-sized veins, can be used depending on body size of recipient and availability of vessel grafts.
Keywords : Interposition; Venoplasty; Pediatric transplantation

 

November 2019, 23 (4)