Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report.
Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor's opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient's HV and the donor's opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology.
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Yukihiro
Y
Sanada
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Yasunaru
Y
Sakuma
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Hideki
H
Sasanuma
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Atsushi
A
Miki
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Takumi
T
Katano
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Yuta
Y
Hirata
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Noriki
N
Okada
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Naoya
N
Yamada
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Yoshiyuki
Y
Ihara
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Taizen
T
Urahashi
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Naohiro
N
Sata
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Yoshikazu
Y
Yasuda
Yukihiro Sanada, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan.
Koichi
K
Mizuta
D000293:Adolescent; D001656:Biliary Atresia / Q000601:surgery; D003251:Constriction, Pathologic / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D011183:Postoperative Complications; D000069590:Round Ligaments / Q000601:surgery; D012772:Shock, Septic / Q000401:mortality; D013927:Thrombosis / Q000473:pathology
All-in-one venoplasty; Hepatic venous reconstruction; Living donor liver transplantation; Opened round ligament; Venous patch graft
Transplantation. 2001 Mar 27;71(6):812-4
11330547
Am J Transplant. 2014 Jun;14(6):1453-8
24725262
Liver Transpl. 2014 Feb;20(2):173-81
24382821
Transpl Int. 2007 Aug;20(8):697-701
17511830
J Hepatobiliary Pancreat Surg. 2008;15(6):581-4
18987926
Liver Transpl. 2016 Feb;22(2):192-200
26390259
Liver Transpl. 2012 May;18(5):602-7
22253117
J Am Coll Surg. 2013 Aug;217(2):e9-11
23870231
Transplant Proc. 2011 Sep;43(7):2817-9
21911171
Liver Transpl. 2012 Aug;18(8):955-65
22511404
Surg Today. 2015 Apr;45(4):522-5
25231939
Ann Surg. 2003 Feb;237(2):180-5
12560775
Liver Transpl. 2013 Nov;19(11):1245-51
23894128
J Am Coll Surg. 2000 Apr;190(4):497-501
10757391
Liver Transpl. 2005 Jun;11(6):644-9
15915499
Transpl Int. 2010 Apr 1;23(4):436-7
19737372
J Hepatobiliary Pancreat Surg. 2006;13(2):131-8
16547674
HPB (Oxford). 2012 Apr;14 (4):274-8
22404267
Liver Transpl. 2008 May;14(5):706-8
18433050
Liver Transpl. 2007 May;13(5):769-72
17457890
Surg Today. 2013 Jul;43(7):769-76
23247889
Liver Transpl. 2004 Apr;10(4):541-7
15048798
Liver Transpl. 2005 Jan;11(1):104-7
15690544
J Hepatobiliary Pancreat Surg. 2007;14(3):270-5
17520202