title: Alternatives for vascular reconstruction in pediatric living donor liver transplantation.
abstract: Many publications discuss the various strategies for vascular reconstruction (VR) in pediatric LDLT. Having knowledge of alternative techniques is helpful in planning transplants. This article presents three case reports that illustrate some of the alternative techniques for HV, PV, and HA reconstruction in pediatric LDLT. It also reviews the available alternative strategies reported for VR in pediatric LDLT. In the first case, a 13-month-old girl presented a PRETEXT III HB with invasion of the retrohepatic vena cava. An LLS graft HV was anastomosed to a DD iliac vein graft and subsequently implanted in a "standard" fashion in the recipient. In the second case, a 44-month-old boy presented with multifocal HB and portomesenteric thrombosis and the portal inflow was done through a renoportal anastomosis. In the third case, a 22-month-old child with a failed Kasai procedure had extensive HA thrombosis. The HA reconstruction was performed with an interposition of the recipient's IMV graft. The use of alternative techniques for VR in pediatric LDLT is paramount to the success of such a complex procedure. Imaging studies can help transplant surgeons outline surgical strategies and define the best technique to be used in each case.
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Joao Seda
authors.initials: JS
authors.lastname: Neto
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Fonseca
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Helry L
authors.initials: HL
authors.lastname: Cândido
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Pugliese
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Flavia H
authors.initials: FH
authors.lastname: Feier
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Mario
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Radiology Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Rodrigo L
authors.initials: RL
authors.lastname: Azambuja
authors.affiliation: Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Chapchap
keywords: hepatic artery; hepatic vein; hepatoblastoma; living donor; portal vein