Vascular Graft From the Recipient's External Jugular Vein to Form a Portoportal Anastomosis During Liver Transplant in a Child With Hepatoblastoma: a Single-Center Experience.
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OBJECTIVES: We investigated hepatoblastoma with invasion into the vessels of the portal vein and widespread thrombosis of the portal vein, where tumor resection is impossible, that was treated with liver transplant. MATERIALS AND METHODS: Examination of 5-year-old boy (15 kg) diagnosed with hepatoblastoma of the liver of fetal epithelial variant without signs of metastasis, showed alpha-fetoprotein level of 22684 IU/mL, which decreased to 16 IU/mL after polychemotherapy. Abdominal ultrasonography showed signs of a space-occupying lesion in the right liver lobe, cavernous transformation of the portal vein, hepatosplenomegaly, and diffuse focal changes in the liver. Abdominal computed tomography showed signs of liver space-occupying lesions and invasion into the inferior vena cava and cavernous transformation of the portal vein, hepatosplenomegaly, and dilatation of intra- and extrahepatic bile ducts. The child received transplant of 2 and 3 liver segments from a living related donor. Extensive thrombosis of the portal vein was detected in the recipient, and thrombectomy was performed. To perform a portal anastomosis, a venous graft from the external jugular vein on the left, 3 cm long, was taken from the recipient. Because a portal anastomosis directly with the native portal vein of the recipient was not possible because of multiple vascular transformation, anastomosis was performed between the portal vein of the donor liver and the superior mesenteric vein of the recipient and graft from the external jugular vein. RESULTS: In the early postoperative period, against the background of satisfactory liver graft function, decreased liver transaminases, bilirubin, and alpha-fetoprotein were noted. Doppler sonography showed satisfactory blood flow. CONCLUSIONS: Despite pronounced vascular transformation of the portal vein with partial thrombosis of the portal vein in the recipient, the use of a native vascular graft from the external jugular vein of the recipient himself to form a portoportal anastomosis was an optimal solution.