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. 2010:2010:828326.
doi: 10.1155/2010/828326. Epub 2010 Jul 27.

Life-saving super-urgent liver transplantation with replacement of retrohepatic vena cava by dacron graft

Paolo Aseni  1 , Andrea Lauterio, Abdallah Omar Slim, Alessandro Giacomoni, Luca Lamperti, Luciano De Carlis
Affiliations

Life-saving super-urgent liver transplantation with replacement of retrohepatic vena cava by dacron graft

Paolo Aseni et al. HPB Surg. 2010.

Abstract

We describe a modified technique of side-to-side cavo-cavostomy by Dacron interposition prosthesis during a super urgent liver transplantation. A liver graft from a deceased donor was immediately requested on a top priority basis as a consequence of massive bleeding during extended left hepatectomy for a huge hepatic haemangioma arising from the caudate lobe. Veno-venous bypass was employed during anhepatic phase but it was disconnected due to severe fibrinolysis and hypothermia. A porto-caval shunt was performed and the inferior vena cava outflow was restored by a Dacron interposition prosthesis. A liver graft from a deceased donor was available 16 hours later. Due to the shortness of the vena cava of the donor liver graft, the removal of the Dacron graft was impossible and a modified side-to-side cavo-cavostomy between the Dacron interposition graft and the vena cava of the donor liver was than performed. Liver transplantation was uneventful and the patient is doing well 25 months after the surgical procedure. Although the use of synthetic vascular prosthesis should usually be discouraged during organ transplantation, its exceptional use during liver transplantation is possible with long-term good results.

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Figures

Figure 1
Figure 1
Pre-operative CT scan (coronal view) of the huge hepatic tumour with compression and right dislocation of the interior vena cava (arrows).
Figure 2
Figure 2
Pre-operative CT scan showing the huge hepatic mass arising from the caudate lobe with a right sided dislocation of the inferior vena cava (arrow).
Figure 3
Figure 3
(a) Dacron prosthesis with a wide elliptical incision. (b) Lateral view of the transplanted liver with a wide side-to-side anastomosis between Dacron interposition graft (DG) and the inferior vena cava of the donor liver graft (IVCg) (*portal vein stump).
Figure 4
Figure 4
Postoperative CT scan (four months p.o), showing the liver graft with the patent Dacron prosthesis (arrow).
See this image and copyright information in PMC

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