Successful treatment for end stage liver alveolar echinococcosis with <i>ex-vivo</i> liver resection and autologous liver transplantation combined with complicated hepatic vein reconstruction _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Yu ¹ , YANG Chong ¹ , WANG Yi ¹ , YANG Hongji ¹ , LIU Jun ² , XIAN Di ¹ , ZHOU Guo ² ,  DENG Shaoping ¹

1. Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
2. Ultrasonic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;

Corresponding author：

ZHANG Yu, Email: 68532815@qq.com; DENG Shaoping, Email: Sdeng10@163.com

Keywords：

hepatic alveolar echinococcosis; autologous liver transplantation; ex-vivo liver resection; hepatic vein reconstruction

DOI：

10.7507/1007-9424.201805108

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effect of ex-vivo liver resection and autologous liver transplantation (ERAT) combined with complicated hepatic venous reconstruction for end stage hepatic alveolar echinococcosis (AE). Method Theclinical data of one case with hepatic AE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in December 2017 was analyzed retrospectively. Results Pre-operative examination and intraoperative exploration revealed the hepatic vein (HV) and retrohepatic inferior vena cava (RHIVC) were invaded widely. We successfully initiated operation through vivo and ex-vivo hepatic AE resection, portal vein reconstruction, right/short/right inferior HV reconstruction into a wide mouth outflow with the assist of autogenous saphenous vein, and then piggyback autologous liver transplantation by wide mouth outflow-artificial inferior vena cava anastomosis (side to side). The operative time was 16 hours, and blood loss was 1 000 mL approximately. The patient was admitted routine treatment after hepatectomy. The inject low-molecular-weight heparin sodium was admitted for anticoagulant therapy 24 hours after operation. This patient recovered smoothly without bile leakage, bleeding, infection and liver failure, and so on. The patient was discharged uneventfully 14 days after operation, and there was no special situation during the6 months follow-up period. Conclusions ERAT is an ideal surgical method for end stage hepatic AE. Hepatic parenchymal transection and individual duct reconstruction, especially hepatic outflow reconstruction, are the key steps for ERAT.

Citation： ZHANG Yu, YANG Chong, WANG Yi, YANG Hongji, LIU Jun, XIAN Di, ZHOU Guo, DENG Shaoping. Successful treatment for end stage liver alveolar echinococcosis with ex-vivo liver resection and autologous liver transplantation combined with complicated hepatic vein reconstruction . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(10): 1236-1241. doi: 10.7507/1007-9424.201805108 Copy

1.	Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
2.	四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
3.	陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
4.	赵海平. 复杂肝包虫病的诊治. 中国普外基础与临床杂志, 2017, 24(7): 788-791.
5.	McManus DP, Zhang W, Li J, et al. Echinococcosis. Lancet, 2003, 362(7): 1295-1300.
6.	Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
7.	Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
8.	Haider HH, Nishida S, Selvaggi G, et al. Alveolar echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant, 2008, 22(5): 664-667.
9.	Wen H, Dong JH, Zhang JH, et al. Ex Vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
10.	Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
11.	杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病 21 例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
12.	Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
13.	吐尔洪江·吐逊, 阿卜杜萨拉木·艾尼, 李玉鹏, 等非原位肝切除技术安全性、可行性和有效性的系统评价. 中华医学杂志, 2016, 96(28): 2251-2257.
14.	Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
15.	方丹, 杨康明, 陈哲宇, 等. 分期切除治疗多发泡型肝包虫病的初步经验. 中国普外基础与临床杂志, 2017, 24(7): 804-807.
16.	沈中阳. 中国肝移植 10 年成就与展望. 华夏医药, 2009, 4(6): 419-420.
17.	Ji XW, Zhang JH, Zhao JM, et al. Liver transplantation for the treatment for end-stage hepatic alveolar echinococcosis. Chin J Dig Surg (Chin), 2011, 10(6): 296-298.
18.	Lin RY, Wang JH, Lu XM, et al. Components of the mitogen-activated protein kinase cascade are activated in hepatic cells by Echinococcus multilocularis metacestode. World J Gastroenterol, 2009, 15(17): 2116-2124.
19.	吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等肝泡型包虫病自体肝移植中提升功能肝" 量与质”的临床实践: 附12例临床病例分析. 中华医学杂志, 2017, 97(4): 270-275.
20.	He YB, Bai L, Jiang Y, et al. Application of a three-dimensional reconstruction technique in liver autotransplantation for end-stage hepatic alveolar echinococcosis. J Gastrointest Surg, 2015, 19(8): 1457-1465.
21.	何翼彪, 白磊, 吐尔干艾力·阿吉, 等数字化三维重建技术在肝泡型包虫病肝移植中的应用. 中华肝脏外科手术学电子杂志, 2015, 4(5): 279-283.
22.	何翼彪, 白磊, 李涛, 等. 三维可视化技术在肝泡型包虫病外科治疗中的应用. 中华外科杂志, 2016, 54(9): 704-709.
23.	Hu H, Huang B, Zhao J, et al. Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis. J Surg Res, 2017, 210: 169-176.
24.	Ikegami T, Soejima Y, Taketomi A, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation, 2007, 84(7): 836-841.
25.	Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein. Hepatol Res, 2007, 37(12): 1044-1051.
26.	Ikegami T, Shirabe K, Yoshiya S, et al. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation. Surg Today, 2013, 43(7): 769-776.
27.	Lei JY, Hao JC, Wang WT, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
28.	Cheng F, Yang Z, Zeng J, et al. Anesthesia management of modified ex vivo liver resection and autotransplantation. Ann Transplant, 2018, 23: 274-284.
29.	Qin Y, Li X, Zhang Q, et al. Analysis of the clinical value of¹⁸F-FDG PET/CT in hepatic alveolar echinococcosis before and after autologous liver transplantation. Exp Ther Med, 2016, 11(1): 43-48.
30.	Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. Transplantation, 2003, 75(8): 1313-1317.
31.	Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure <15 mm Hgis a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl, 2010, 16(6): 718-72.

1. Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
2. 四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
3. 陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
4. 赵海平. 复杂肝包虫病的诊治. 中国普外基础与临床杂志, 2017, 24(7): 788-791.
5. McManus DP, Zhang W, Li J, et al. Echinococcosis. Lancet, 2003, 362(7): 1295-1300.
6. Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
7. Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
8. Haider HH, Nishida S, Selvaggi G, et al. Alveolar echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant, 2008, 22(5): 664-667.
9. Wen H, Dong JH, Zhang JH, et al. Ex Vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
10. Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
11. 杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病 21 例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
12. Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
13. 吐尔洪江·吐逊, 阿卜杜萨拉木·艾尼, 李玉鹏, 等非原位肝切除技术安全性、可行性和有效性的系统评价. 中华医学杂志, 2016, 96(28): 2251-2257.
14. Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
15. 方丹, 杨康明, 陈哲宇, 等. 分期切除治疗多发泡型肝包虫病的初步经验. 中国普外基础与临床杂志, 2017, 24(7): 804-807.
16. 沈中阳. 中国肝移植 10 年成就与展望. 华夏医药, 2009, 4(6): 419-420.
17. Ji XW, Zhang JH, Zhao JM, et al. Liver transplantation for the treatment for end-stage hepatic alveolar echinococcosis. Chin J Dig Surg (Chin), 2011, 10(6): 296-298.
18. Lin RY, Wang JH, Lu XM, et al. Components of the mitogen-activated protein kinase cascade are activated in hepatic cells by Echinococcus multilocularis metacestode. World J Gastroenterol, 2009, 15(17): 2116-2124.
19. 吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等肝泡型包虫病自体肝移植中提升功能肝" 量与质”的临床实践: 附12例临床病例分析. 中华医学杂志, 2017, 97(4): 270-275.
20. He YB, Bai L, Jiang Y, et al. Application of a three-dimensional reconstruction technique in liver autotransplantation for end-stage hepatic alveolar echinococcosis. J Gastrointest Surg, 2015, 19(8): 1457-1465.
21. 何翼彪, 白磊, 吐尔干艾力·阿吉, 等数字化三维重建技术在肝泡型包虫病肝移植中的应用. 中华肝脏外科手术学电子杂志, 2015, 4(5): 279-283.
22. 何翼彪, 白磊, 李涛, 等. 三维可视化技术在肝泡型包虫病外科治疗中的应用. 中华外科杂志, 2016, 54(9): 704-709.
23. Hu H, Huang B, Zhao J, et al. Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis. J Surg Res, 2017, 210: 169-176.
24. Ikegami T, Soejima Y, Taketomi A, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation, 2007, 84(7): 836-841.
25. Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein. Hepatol Res, 2007, 37(12): 1044-1051.
26. Ikegami T, Shirabe K, Yoshiya S, et al. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation. Surg Today, 2013, 43(7): 769-776.
27. Lei JY, Hao JC, Wang WT, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
28. Cheng F, Yang Z, Zeng J, et al. Anesthesia management of modified ex vivo liver resection and autotransplantation. Ann Transplant, 2018, 23: 274-284.
29. Qin Y, Li X, Zhang Q, et al. Analysis of the clinical value of¹⁸F-FDG PET/CT in hepatic alveolar echinococcosis before and after autologous liver transplantation. Exp Ther Med, 2016, 11(1): 43-48.
30. Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. Transplantation, 2003, 75(8): 1313-1317.
31. Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure <15 mm Hgis a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl, 2010, 16(6): 718-72.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Successful treatment for end stage liver alveolar echinococcosis with ex-vivo liver resection and autologous liver transplantation combined with complicated hepatic vein reconstruction

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