Pediatric living donor liver transplantation for congenital hepatic fibrosis using a mother's graft with von Meyenburg complex: A case report

This is the first report of living donor liver transplantation(LDLT) for congenital hepatic fibrosis(CHF) using a mother's graft with von Meyenburg complex. A 6-year-old girl with CHF, who suffered from recurrent gastrointestinal bleeding, was referred to our hospital for liver transplantation. Her 38-year-old mother was investigated as a living donor and multiple biliary hamartoma were seen on her computed tomography and magnetic resonance imaging scan. The mother's liver function tests were normal and she did not have any organ abnormality, including polycystic kidney disease. LDLT using the left lateral segment(LLS) graft from the donor was performed. The donor LLS graft weighed 250 g; the graft recipient weight ratio was 1.19%. The operation and post-operative course of the donor were uneventful and she was discharged on post-operative day(POD) 8. The graft liver function was good, and the recipient was discharged on POD 31. LDLT using a graft with von Meyenburg complex is safe and useful. Long-term follow-up is needed with respect to graft liver function and screening malignant tumors.

Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor

A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son,who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years.The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation.With the use of cholangiography at the time of surgery,we found the right anterior segmental duct(RASD) emptying directly into the cystic duct,and the catheter passed into the RASD.After repairing the incision in the cystic duct,transplantation was successfully performed.Her postoperative course was uneventful.Biliary anatomical variations were frequently encountered,however,this variation has very rarely been reported.If the RASD was divided,the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor.Meticulous preoperative evaluation of the living donor's biliary anatomy,especially using magnetic resonance cholangiography and careful intraoperative techniques,is important to prevent bile duct injury and avoid the risk to the healthy donor.

Clearance of the liver remnant predicts short-term outcome in patients undergoing resection of hepatocellular carcinoma

BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma(HCC).METHODS We reviewed the medical records of 199 patients who underwent resection of HCC.Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography.Posthepatectomy liver failure(PHLF)was classified according to the International Study Group of Liver Surgery.Complications was classified according to Clavien–Dindo classification.We analyzed by the risk factors for PHLF,morbidity and mortality with multivariate analysis.RESULTS Twenty-seven(30%)patients had major complications and 23(12%)developed PHLF.The incidence of major complications increased with increasing albumin–bilirubin(ALBI)grade.The area under the curve values for hepatic clearance of the remnant liver,liver to heart-plus-liver radioactivity at 15 min(LHL15),and ALBI score predicting PHLF were 0.868,0.629,and 0.655,respectively.The area under the curve for hepatic clearance of the remnant liver,LHL15,and ALBI score predicting major complications were 0.758,0.594,and 0.647,respectively.The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.CONCLUSION The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.

Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial,and there are no pathological analyses of this procedure. Herein,we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation(LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins(HVs),which included the right HV(RHV; 15 mm) and the inferior RHV(IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor's opened round ligament(60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs,but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology,there was adequate patency and continuity between the recipient's HV and the donor's opened round ligament. In addition,the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT,as observed on pathology.