Ann Surg Treat Res.  2014 Aug;87(2):108-111. 10.4174/astr.2014.87.2.108.

Salvage dual graft living donor liver transplantation after major hepatectomy

• Kim JD
• Choi DL
• Han YS

• KMID: 1882840
• DOI: http://doi.org/10.4174/astr.2014.87.2.108

Abstract

Salvage living donor liver transplantation (LDLT) after major hepatectomy has been considered a challenging procedure due to operative complexity. We report a successful case of salvage dual graft LDLT after right hepatectomy. A 48-year-old male was transferred to Daegu Catholic University Medical Center because of duodenal variceal bleeding. He underwent right hepatectomy due to hepatocellular carcinoma four years prior. We performed LDLT with dual graft from his wife and sister. During operation, portal vein anastomosis of the right lobe graft was performed using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft. Adequate graft inflow was demonstrated by postoperative imaging studies. He has been doing well with normal graft function for 31 months. Salvage dual graft LDLT could be undertaken successfully in patients with prior major hepatectomy under accurate preoperative planning and proper surgical techniques.

Keyword

Salvage therapy; Liver transplantation; Living donors; Dual; Hepatectomy

MeSH Terms

Academic Medical Centers
Cadaver
Carcinoma, Hepatocellular
Daegu
Esophageal and Gastric Varices
Gastroepiploic Artery
Hepatectomy*
Hepatic Artery
Humans
Iliac Vein
Liver Transplantation*
Living Donors*
Male
Middle Aged
Portal Vein
Salvage Therapy
Siblings
Spouses
Transplants*

Figure

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  Fig. 1 Intraoperative photographs showing salvage living donor liver transplantation with dual graft. (A) Severe perihepatic adhesion was exposed after complete mobilization of remnant liver. (B) We isolated the only remnant left hepatic artery (arrow) and short stump of right portal vein above bifurcation (arrowhead) after hilar dissection.

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  Fig. 2 Intraoperative photograph (A) and illustration (B) of vascular and biliary reconstruction of salvage dual graft living donor liver transplantation. Cryopreserved iliac vein conduit was interposed from portal vein of right-sided graft to right portal vein stump of recipient (arrow) and recipient's right gastroepiploic artery (arrowhead) was anastomosed to left hepatic artery of left-sided graft.

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  Fig. 3 Postoperative Doppler ultrasonography and CT scan. (A) Doppler ultrasonography showed good hepatic artery flow to left-sided graft using right gastroepiploic artery. (B) Dynamic CT scan on postoperative day 14 demonstrated good portal flow to both grafts. (C) The CT scan on 2 years after transplantation also showed good patency of interposed vein graft (arrowhead) used for portal vein reconstruction.

Reference

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