Ann Liver Transplant.  2024 Nov;4(2):134-140. 10.52604/alt.24.0023.

Portal vein interposition in living donor liver transplantation for a pediatric patient with hepatoblastoma invading the portal vein

• Namgoong JM
• Hwang S
• Park GC
• Kwon H
• Ha S
• Gang S
• Park J
• Kim KM
• Oh SH

• KMID: 2561861
• DOI: http://doi.org/10.52604/alt.24.0023

Abstract

Liver transplantation is accepted as an effective therapeutic option for unresectable hepatoblastoma. We present a pediatric case of hepatoblastoma patient with portal vein (PV) tumor thrombosis (PVTT) that occluded the main PV completely despite aggressive neoadjuvant chemotherapy. The patient was a 4-year and 2-month-old 17-kg boy suffering from hepatoblastoma with PVTT, which was partially regressed by neoadjuvant chemotherapy. Viable PVTT remained after right trisectionectomy and repetition of systemic chemotherapy. To remove the tumor completely, we performed living donor liver transplantation (LDLT) using his father’s left liver graft. The native PV was completely occluded with PVTT and abundant pericholedochal collaterals developed. The native PV was meticulously dissected to fully expose the superior mesenteric vein-splenic vein confluence. This confluence portion was deeply clamped and opened to use as a viable PV inflow source. A cold-stored fresh external iliac vein homograft was anastomosed to the confluence portion as an end-to-end fashion and passed through the native retropancreatic PV tract after mechanical dilatation of the tract. Left liver graft implantation was performed using standard procedures of pediatric LDLT. The patient recovered uneventfully. He will undergo scheduled adjuvant chemotherapy. Customized design for PV reconstruction using interposition vein graft with viable PV inflow source can result in successful PV reconstruction with complete removal of PVTT.

Keyword

Interposition; Venoplasty; Pediatric transplantation; Portal vein tumor thrombosis; Neoadjuvant chemotherapy