Feasibility of using the graft's umbilical vein as a patch graft for hepatic vein reconstruction in pediatric living donor liver transplantation

摘要

A 5-month-old male (body weight, 9.4 kg) underwent living donor liver transplantation (LDLT) for ornithine transcarbamylase deficiency arising out of several episodes of hyperammonemia refractory to the medical management. The recipient's hepatectomy was uneventfully performed by retaining the inferior vena cava (IVC), and a reduced left lateral segment (weight, 266 g) was donated by his 37-year-old father. All of the recipient's hepatic vein orifices were connected to create a wide orifice, and the hepatic venous branches of the graft were anastomosed to the recipient's orifice in an end-to-side manner using continuous 6-0 mononlament sutures. After reper-fusion, the graft became congested and ultrasound (US) revealed dilated intrahepatic veins. Although the graft was placed in an appropriate position without any torsion, a narrowing of the IVC was observed at the anastomotic site. While the hepatic inflows were clamped, the anastomosis was detached with the circumferential excision of the stenotic site of the IVC. Then, the posterior walls of the IVC were anastomosed to each other and the hepatic venous branches of the graft were anastomosed to the anterior wall of the IVC in an end-to-side manner using continuous 6-0 mononlament sutures. However, there was no improvement in the outflow obstruction. The graft's umbilical vein had sufficient length and its patency had been well maintained. The umbilical vein was longitudinally opened to make a sheet (Fig. la). The hepatic inflows were clamped, the anterior side of the previous anastomosis was released and the sheet of the umbilical vein was applied as a patch graft (Fig. Ib and c). The graft's congestion was resolved and US revealed hepatic venous outflow to be adequate. The recipient demonstrated a good recovery without any signs of outflow obstruction.