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Graft outflow vein venoplasty for a laparoscopically harvested left lateral section graft in pediatric living donor liver transplantation

대한이식학회지 2020년 34권 3호 p.210 ~ 216
Namgoong Jung-Man, 황신, Kim Ki-Hum, 박길춘, 김경모, 오석희, 권현희, 권영재,
소속 상세정보
 ( Namgoong Jung-Man ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
황신 ( Hwang Shin ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Kim Ki-Hum ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
박길춘 ( Park Gil-Chun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김경모 ( Kim Kyung-Mo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pediatrics
오석희 ( Oh Seak-Hee ) - University of Ulsan College of Medicine Asan Medical Center Department of Pediatrics
권현희 ( Kwon Hyun-Hee ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
권영재 ( Kwon Yong-Jae ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

Abstract


Laparoscopically harvested left lateral section (LLS) grafts have drawbacks regarding the size of the graft left hepatic vein (LHV) orifice although they have the merit of cosmetics concerning the donor’s wound. We present a case of pediatric living donor liver transplantation (LDLT) using a laparoscopically harvested LLS graft and describe the refined surgical techniques for graft LHV venoplasty with a circumferential vein patch. The patient was a 46-month-old boy with marked growth retardation who was diagnosed with progressive familial intrahepatic cholestasis type 2. The donor was his 25-year-old mother. The LLS graft weighed 285 g. A circumferential patch of external iliac vein homograft was attached to the graft LHV orifice after incisions were made at the medial wall of the LHV trunk and superficial LHV branch, which made the graft LHV orifice much larger. The recipient’s hepatic vein orifice was also enlarged by unifying the three hepatic vein orifices. Other surgical procedures followed the standard LDLT operation. This patient recovered uneventfully and has been doing well for 1 year. In conclusion, our incision-and-patch venoplasty to enlarge the graft outflow vein orifice was beneficial for reducing the risk of hepatic vein outflow obstruction in LDLT using a laparoscopically harvested LLS graft.

키워드

Left hepatic vein; Venoplasty; Vein patch; Stenosis; Pediatric transplantation

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