title: Functional portal flow competition after auxiliary partial orthotopic living donor liver transplantation in noncirrhotic metabolic liver disease.
abstract: Auxilliary partial orthotopic liver transplantation (APOLT) was introduced initially as a tentative or permanent support for patients with potentially reversible fulminant hepatic failure and has extended its indication to congenital metabolic disorder of the liver that has otherwise normal functional integrity. Postoperative management of APOLT is complicated because of functional portal flow competition between the native and graft liver. The native portal vein diversion to the graft is sometimes indicated to prevent functional competition; however, it is still an open question whether this technique can be theoretically indicated for APOLT patients. The authors report a on patient with ornithine transcarbamylase deficiency who received APOLT from a living donor without native portal vein diversion. Because of functional portal vein competition between the native and graft liver, the patient had to have portal vein diversion, portal vein embolization, and finally native hepatectomy to induce the graft regeneration after APOLT. After the experience of the current case, primary portal vein diversion for APOLT with noncirrhotic metabolic liver disease patients to prevent functional portal flow competition is recommended.
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Koichi
authors.initials: K
authors.lastname: Kozaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology; D008102:Liver Circulation; D008107:Liver Diseases / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D019520:Living Donors; D011168:Portal System / Q000503:physiopathology* / Q000601:surgery; D012086:Reoperation