title: Paediatric liver re-transplantation after primary partial liver graft transplantation: a report of four cases.
abstract: OBJECTIVE
  To discuss rules of anatomic shifting of the porta hepatis structures of the original graft and dissection techniques for the portal vein (pull-out technique) in pediatric liver re-transplantation.
  
  
  METHODS
  We summarized four cases of paediatric liver re-transplantation. The main donor type is partial liver graft especially using the left lateral lobe.
  
  
  RESULTS
  In paediatric liver re-transplantation, gross morphological changes were observed in the liver, and the spatial position of the porta hepatis structures was shifted clockwise (with the anastomosis of the hepatic vein as the origin). Preoperative three-dimensional imaging showed that segment 3 of the liver graft increased in a compensatory manner. The pull-out technique could expose the surgical field without dissection and separation, and reduce the technical difficulty of identifying and dissociating the anatomical structures.
  
  
  CONCLUSIONS
  Changes in the spatial location and structure of the liver portal anatomy increase the difficulties and risks of surgery. We can reduce the difficulty of surgical anatomy, and the risk of bleeding and injury and increase the safety of paediatric liver re-transplantation by evaluation and the application of special techniques.
authors.affiliation: Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: W
authors.initials: W
authors.lastname: Qu
authors.affiliation: Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: L
authors.initials: L
authors.lastname: Wei
authors.affiliation: Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: L
authors.initials: L
authors.lastname: Sun
authors.affiliation: Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Zeng
mesh_terms: D000359:Aftercare; D001656:Biliary Atresia / Q000601:surgery; D016063:Blood Loss, Surgical; D002648:Child; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D061646:Operative Time; D011169:Portal Vein / Q000601:surgery; D016896:Treatment Outcome