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Marek Szymczak, Piotr J. Kaliciński, Grzegorz Kowalewski, Mateusz Ciopiński, Małgorzata Markiewicz-Kijewska, Dorota Broniszczak, Bożenna Dembowska-Bagińska, Andrzej Kościesza, Grażyna Brzezińska-Rajszys, Waldemar Patkowski, Marek Stefanowicz
(Department of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, Warsaw, Poland)
Ann Transplant 2021; 26:e926217
In this report, we present technical problems and solutions used in the reconstruction of the inferior vena cava and graft venous outflow during living donor liver transplantation (LDLT) in children.
MATERIAL AND METHODS: In 65 grafts out of 379 liver transplantations from living donors, reconstruction of multiple hepatic venous branches and/or IVC was necessary. In 4 cases, cryopreserved deceased donor venous grafts were used for the reconstruction of the IVC and/or HV.
RESULTS: Follow-up ranged from 2 months to 17.8 years (median 7.2 years). In 4 children, liver re-transplantation was required for a reason not related to venous outflow (biliary complications in 3 patients, graft insufficiency caused by small-for-size syndrome). Two patients died: 1 due to tumor recurrence and 1 due to multi-organ failure. Fifty-nine patients are alive with good liver function. One patient (1.5%) after deceased donor venous graft reconstruction showed symptoms of venous outflow obstruction, which was successfully treated with endovascular balloon angioplasty and stent placement. The remaining 59 transplanted patients do not show any signs of venous outflow obstruction.
CONCLUSIONS: In most cases, the reconstruction of multiple hepatic veins of living donor allografts can successfully be done with local venoplasty, while using cold-stored vein grafts may be helpful in selected cases of LDLT.
Keywords: Allografts, Liver Transplantation, Living Donors, inferior vena cava