Living-related liver transplantation and vena cava reconstruction after total hepatectomy including the vena cava for hepatoblastoma.
BACKGROUND
In most cases of total hepatectomy (TH) required for hepatoblastoma (HB), the retrohepatic inferior vena cava (IVC) has to be removed with the native liver for complete tumor excision. Because the liver graft procured by living donation has no IVC, a reconstruction of the recipient IVC is needed. We report our experience with living-related liver transplantation (LRLT) and IVC replacement in such cases.


METHODS
Between May 1998 and December 1999, four children underwent TH, including IVC and LRLT with IVC replacement for otherwise irresectable HB after chemotherapy (SIOPEL 2 and 3 protocols). IVC reconstruction used an allogenic iliac vein procured from a cadaveric donor (bank graft) in two cases and an internal jugular vein procured from the donor parent in two cases. Median age and weight at surgery were 17 months (range 10-60) and 9.6 kg (range 8.3-17.9).


RESULTS
In the living donors, there were two complications of the procurement: one intra-abdominal biliary collection and one subcutaneous abscess. In all four children, complete excision of the tumor could be achieved without any intra-operative complication. One patient died 5 months after LRLT due to lung metastases. Three patients were alive and well with no evidence of tumor recurrence 13-24 months after surgery. Reconstructed IVC was patent in two patients, and asymptomatic thrombosis occurred 2 years after operation in one patient.


CONCLUSIONS
Total hepatectomy including the retrohepatic IVC is not a technical obstacle to LRLT. Therefore, scheduled surgery, at the best time after chemotherapy, can be considered in all patients with otherwise irresectable HBs.
Chardot
Christophe
C
Centre Hospitalier Universitaire de Bicêtre, 78 rue du Général Leclerc, F-94275 Le Kremlin Bicetre, France. christophe.chardot@bct.ap-hop-paris.fr
Saint Martin
Christine
C
Gilles
André
A
Brichard
Bénédicte
B
Janssen
Magda
M
Sokal
Etienne
E
Clapuyt
Philippe
P
Lerut
Jan
J
Reding
Raymond
R
Otte
Jean-Bernard
JB
D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D005220:Fathers; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D018197:Hepatoblastoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary; D008297:Male; D009035:Mothers; D019651:Plastic Surgery Procedures; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins