Korean J Transplant.  2021 Sep;35(3):183-188. 10.4285/kjt.20.0059.

Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

• Moon DB
• Hwang S
• Jung DH
• Ahn CS
• Park GC
• Ha TY
• Song GW
• Yoon YI
• Lee SG

• KMID: 2520684
• DOI: http://doi.org/10.4285/kjt.20.0059

Abstract

We have preferentially used the right gastroepiploic artery (RGEA) as an alternative for the recipient hepatic artery (HA) inflow during living donor liver transplantation (LDLT), but it was not always available. We herein present a case of adult LDLT with HA reconstruction using a greater saphenous vein (GSV) conduit because of the absence of the RGEA due to prior subtotal gastrectomy. A 55-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis and secondary biliary cirrhosis underwent LDLT using a modified right liver graft. The upper abdominal cavity was heavily adhered due to prior abdominal surgeries, thus we had to sacrifice the common bile duct and the right HA completely. A 6-cm-long GSV segment was harvested from the left ankle and interposed between the recipient gastroduodenal artery and the graft HA. The patient recovered from LDLT and HA complications did not occur. However, 8 years after LDLT, chronic rejection occurred, thus repeated deceased donor liver transplantation was performed. This patient has been doing well for 2 years after retransplantation. In conclusion, we suggest that interposition of an autologous GSV conduit can be an alternative for establishing HA inflow in LDLT when other inflow source is not available.

Keyword

Liver transplantation; Hepatic artery thrombosis; Vascular interposition; Living donor; Saphenous vein; Case report

Figure

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  Fig. 1 Pretransplant dynamic computed tomography findings showing percutaneous transhepatic biliary drainage tube (A) and visualization of the right hepatic artery (B).

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  Fig. 2 Intraoperative photograph showing completion of vascular reconstruction of a modified right liver graft.

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  Fig. 3 Intraoperative photographs showing interposition of the greater saphenous vein conduit between the recipient gastroduodenal artery (A) and the graft right hepatic artery (B).

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  Fig. 4 Photographs of the explant liver showing secondary biliary cirrhosis associated with hepatolithiasis and chronic cholangitis.

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  Fig. 5 Posttransplant liver dynamic computed tomography findings taken at 2 weeks after transplantation. Uneventful visualization of the portal vein (A) and the right hepatic artery (B) is observed. Arrows indicate the running course of the greater saphenous vein conduit.

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  Fig. 6 Posttransplant findings around retransplantation. Computed tomography (CT) scan taken at 8 years after living donor liver transplantation shows liver cirrhosis with splenomegaly (A). The explant liver shows typical findings of chronic rejection (B). No abnormal finding is observed in the CT images taken 3 weeks (C) and 1 year (D) after deceased donor liver retransplantation except for portal vein stenting.

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