title: Technical aspects and outcomes of living donor liver transplantation for pediatric patients with situs inversus.
abstract: The vascular anomalies encountered in patients with biliary atresia associated with polysplenia syndrome and situs inversus (SI) demand technical refinements when liver transplantation is being performed. The available data describing the technique used in living donor liver transplantation (LDLT) in this population are limited; the short vascular stumps of the donor's liver can impart additional technical difficulties during vascular reconstruction. Here we describe our experience with 9 children with biliary atresia and SI who underwent LDLT. In our series, the retrohepatic vena cava was absent for 7 patients, 7 had a preduodenal portal vein (PV), and 4 had a variant arterial anatomy. The donor's left hepatic vein was anastomosed to the confluence of the recipient's 3 hepatic veins in 7 patients. Vascular grafts were used for PV reconstruction in 3 cases. A left lateral segment graft was used in all but 1 patient who needed a graft reduction. All grafts were placed in the upper left abdomen. There were no vascular complications after transplantation. All patients were alive and well at a median follow-up of 55 months. In conclusion, LDLT can be successfully performed in pediatric patients with SI. Complex vascular anomalies associated with the use of partial liver grafts obtained from living donors are not associated with an increased occurrence of vascular complications.
authors: Sirio-Libanes Hospital/A. C. Camargo Hospital, São Paulo, Brazil.
authors: Rodrigo
authors: R
authors: Vincenzi
authors: Joao
authors: J
authors: Seda-Neto
authors: Eduardo Antunes da
authors: EA
authors: Fonseca
authors: Bernardo Mazzini
authors: BM
authors: Ketzer
authors: Marcel
authors: M
authors: Benavides
authors: Helry Lopes
authors: HL
authors: Cândido
authors: Gilda
authors: G
authors: Porta
authors: Irene Kazue
authors: IK
authors: Miura
authors: Renata
authors: R
authors: Pugliese
authors: Vera Baggio
authors: VB
authors: Danesi
authors: Teresa Cristina
authors: TC
authors: Guimaraes
authors: Adriana
authors: A
authors: Porta
authors: Cristian Barbieri
authors: CB
authors: Borges
authors: Mario
authors: M
authors: Kondo
authors: Paulo
authors: P
authors: Chapchap
mesh_terms: D000367:Age Factors; D001656:Biliary Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000002:abnormalities / Q000601:surgery; D012189:Retrospective Studies; D012857:Situs Inversus / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects; D054079:Vascular Malformations / Q000150:complications / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000002:abnormalities / Q000601:surgery