Application of hepatic outflow reconstruction with allograft vascular in <i>ex-vivo</i> liver resection and autologous liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TIAN Mingwu ^1,2 ,  ZHANG Yu ^1,2 ,  DENG Shaoping ^1,2 , YANG Chong ² , YANG Hongji ² , LIU Jun ³ , ZHOU Guo ³ , ZOU Bin ⁴

1. Southwest Medical University Clinical Medicine College, Luzhou, Sichuan 646000, P. R. China;
2. Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
3. Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
4. Center for Disease Control and Prevention of Shiqu County, Shiqu, Sichuan 627350, P. R. China;

Corresponding author：

ZHANG Yu, Email: 68532815@qq.com; DENG Shaoping, Email: sdeng10@163.com

Keywords：

hepatic alveolar echinococcosis; allograft vascular; hepatic outflow reconstruction; autologous liver transplantation; ex-vivo liver resection

DOI：

10.7507/1007-9424.201912062

Video：

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Objective To explore the effect of hepatic outflow reconstruction with allograft vascular in ex-vivo liver resection and autologous liver transplantation.Method The clinical data of a patient with end-stage hepatic alveolar echinococcosis admitted to the Organ Transplantation Center of Sichuan Provincial People’s Hospital in August 2019 who underwent the ex-vivo liver resection and autologous liver transplantation combined with hepatic vein reconstruction with allograft vascular were analyzed retrospectively.Results The patient, a 44-year-old female, was admitted to Sichuan Provincial People’s Hospital for “pain in the right abdomen accompanied by skin and sclera yellow staining for 6⁺ months and aggravated for 20⁺ d”. When the patient was admitted, the general condition was poor, such as hyperbilirubin and hypoproteinemia. The body mass was 45 kg and the standard liver volume was 852 mL. The hydatid lesions corroded the first and second hilum of the liver, the right hepatic vein and the posterior inferior vena cava. It was difficult to reconstruct the outflow tract of the hepatic vein in vivo, and it was extremely difficult to completely remove the hydatid lesions in vivo. After admission, the patient was generally in a good condition after the PTCD treatment, then after discussion and rigorous evaluation, the ex-vivo hepatectomy combined with autologous liver transplantation was required. The operative time was 15 h and the intraoperative blood loss was approximately 2 000 mL. After the operation, the routine treatment was performed, the antiviral treatment was continued, the international standardized ratio value was monitored at 1.5–2.5, and the anti-immune rejection drugs were not needed. The patient was transferred to the general ward on the 4th day after the operation, and there were no bile leakage, bleeding, infection and other complications. the result of postoperative pathological diagnosis was the alveolar echinococcosis. The re-examination of enhanced CT on 1 week after the operation suggested that the hepatic outflow tract of allograft vascular reconstruction was unobstructed, no stenosis and no thrombosis occurred. The patient was following-up at present.Conclusions In treatment of end-stage hepatic alveolar echinococcosis by autologous liver transplantation, reconstruction of hepatic outflow should be individualized. Allograft venous vessels could be used as ideal materials due to their advantages of matched tube diameter and length, no anti-rejection, and low risk of infection.

Citation： TIAN Mingwu, ZHANG Yu, DENG Shaoping, YANG Chong, YANG Hongji, LIU Jun, ZHOU Guo, ZOU Bin. Application of hepatic outflow reconstruction with allograft vascular in ex-vivo liver resection and autologous liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 861-866. doi: 10.7507/1007-9424.201912062 Copy

1.	Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
2.	Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
3.	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.
4.	Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int, 2006, 55(Suppl): S283-S287.
5.	Bresson-Hadni S, Koch S, Miguet JP, et al. Indications and results of liver transplantation for Echinococcus alveolar infection: an overview. Langenbecks Arch Surg, 2003, 388(4): 231-238.
6.	Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg, 2005, 92(9): 1110-1116.
7.	Chapuis Y, Houssin D, Brouzes S, et al. Hepatic transplantation in alveolar echinococcosis. 3 attempts. Chirurgie, 1987, 113(6): 634-640.
8.	Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7): 855-865.
9.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
10.	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.
11.	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.
12.	王燚, 张宇, 邓绍平, 等. 自体肝移植技术治疗晚期肝泡型包虫病 16 例临床疗效分析. 实用医院临床杂志, 2019, 16(3): 59-63.
13.	张宇, 杨冲, 王燚, 等. 原位保留部分残余肝脏的离体肝切除联合辅助性自体肝移植治疗复杂肝泡型包虫病. 中国普外基础与临床杂志, 2019, 26(8): 974-979.
14.	Liu CL, Fan ST. Adult-to-adult live-donor liver transplantation: the current status. J Hepatobiliary Pancreat Surg, 2006, 13(2): 110-116.
15.	Kamei H, Fujimoto Y, Nagai S, et al. Impact of non-congestive graft size in living donor liver transplantation: new indicator for additional vein reconstruction in right liver graft. Liver Transpl, 2007, 13(9): 1295-1301.
16.	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.
17.	Aji T, Dong JH, Shao YM, et al. Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis. J Hepatol, 2018, 69(5): 1037-1046.
18.	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.
19.	严律南, 李波, 卢实春, 等. 同种异体原位肝移植 15 例报告. 中华器官移植杂志, 2000, 21(5): 275-277.
20.	谷川, 沈中阳, 郝明利, 等. 原位肝移植 70 例报告. 中华器官移植杂志, 2001, 22(2): 75-77.
21.	王海涛, 陈强谱. 门静脉肠系膜上静脉修复重建材料的研究进展. 世界华人消化杂志, 2012, 20(26): 2467-2473.
22.	Machado MC, Figueira ER, Machado MA, et al. Portal vein resection: a modified technique for reconstruction after pancreaticoduodenectomy. J Surg Oncol, 2004, 88(1): 52-54.
23.	Kubota K, Makuuchi M, Sugawara Y, et al. Reconstruction of the hepatic and portal veins using a patch graft from the right ovarian vein. Am J Surg, 1998, 176(3): 295-297.
24.	Sakamoto Y, Yamamoto J, Saiura A, et al. Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts. Langenbecks Arch Surg, 2004, 389(2): 110-113.
25.	Chu CK, Farnell MB, Nguyen JH, et al. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg, 2010, 211(3): 316-324.
26.	Stauffer JA, Dougherty MK, Kim GP, et al. Interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy. Br J Surg, 2009, 96(3): 247-252.
27.	Kilic M, Aydin U, Sozbilen M, et al. Comparison between allogenic and autologous vascular conduits in the drainage of anterior sector in right living donor liver transplantation. Transpl Int, 2007, 20(8): 697-701.
28.	李晓锋, 何菊. 同种异体血管在血管外科的应用现状. 实用器官移植电子杂志, 2019, 7(4): 305-307.
29.	Gómez-Caro A, Martinez E, Rodríguez A, et al. Cryopreserved arterial allograft reconstruction after excision of thoracic malignancies. Ann Thorac Surg, 2008, 86(6): 1753-1761.

1. Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
2. Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
3. 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.
4. Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int, 2006, 55(Suppl): S283-S287.
5. Bresson-Hadni S, Koch S, Miguet JP, et al. Indications and results of liver transplantation for Echinococcus alveolar infection: an overview. Langenbecks Arch Surg, 2003, 388(4): 231-238.
6. Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg, 2005, 92(9): 1110-1116.
7. Chapuis Y, Houssin D, Brouzes S, et al. Hepatic transplantation in alveolar echinococcosis. 3 attempts. Chirurgie, 1987, 113(6): 634-640.
8. Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7): 855-865.
9. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
10. 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.
11. 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.
12. 王燚, 张宇, 邓绍平, 等. 自体肝移植技术治疗晚期肝泡型包虫病 16 例临床疗效分析. 实用医院临床杂志, 2019, 16(3): 59-63.
13. 张宇, 杨冲, 王燚, 等. 原位保留部分残余肝脏的离体肝切除联合辅助性自体肝移植治疗复杂肝泡型包虫病. 中国普外基础与临床杂志, 2019, 26(8): 974-979.
14. Liu CL, Fan ST. Adult-to-adult live-donor liver transplantation: the current status. J Hepatobiliary Pancreat Surg, 2006, 13(2): 110-116.
15. Kamei H, Fujimoto Y, Nagai S, et al. Impact of non-congestive graft size in living donor liver transplantation: new indicator for additional vein reconstruction in right liver graft. Liver Transpl, 2007, 13(9): 1295-1301.
16. 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.
17. Aji T, Dong JH, Shao YM, et al. Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis. J Hepatol, 2018, 69(5): 1037-1046.
18. 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.
19. 严律南, 李波, 卢实春, 等. 同种异体原位肝移植 15 例报告. 中华器官移植杂志, 2000, 21(5): 275-277.
20. 谷川, 沈中阳, 郝明利, 等. 原位肝移植 70 例报告. 中华器官移植杂志, 2001, 22(2): 75-77.
21. 王海涛, 陈强谱. 门静脉肠系膜上静脉修复重建材料的研究进展. 世界华人消化杂志, 2012, 20(26): 2467-2473.
22. Machado MC, Figueira ER, Machado MA, et al. Portal vein resection: a modified technique for reconstruction after pancreaticoduodenectomy. J Surg Oncol, 2004, 88(1): 52-54.
23. Kubota K, Makuuchi M, Sugawara Y, et al. Reconstruction of the hepatic and portal veins using a patch graft from the right ovarian vein. Am J Surg, 1998, 176(3): 295-297.
24. Sakamoto Y, Yamamoto J, Saiura A, et al. Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts. Langenbecks Arch Surg, 2004, 389(2): 110-113.
25. Chu CK, Farnell MB, Nguyen JH, et al. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg, 2010, 211(3): 316-324.
26. Stauffer JA, Dougherty MK, Kim GP, et al. Interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy. Br J Surg, 2009, 96(3): 247-252.
27. Kilic M, Aydin U, Sozbilen M, et al. Comparison between allogenic and autologous vascular conduits in the drainage of anterior sector in right living donor liver transplantation. Transpl Int, 2007, 20(8): 697-701.
28. 李晓锋, 何菊. 同种异体血管在血管外科的应用现状. 实用器官移植电子杂志, 2019, 7(4): 305-307.
29. Gómez-Caro A, Martinez E, Rodríguez A, et al. Cryopreserved arterial allograft reconstruction after excision of thoracic malignancies. Ann Thorac Surg, 2008, 86(6): 1753-1761.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of hepatic outflow reconstruction with allograft vascular in ex-vivo liver resection and autologous liver transplantation

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