Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2016; 22(34): 7851-7856
Published online Sep 14, 2016. doi: 10.3748/wjg.v22.i34.7851
Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report
Yukihiro Sanada, Yasunaru Sakuma, Hideki Sasanuma, Atsushi Miki, Takumi Katano, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Naohiro Sata, Yoshikazu Yasuda, Koichi Mizuta
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 Sakuma, Hideki Sasanuma, Atsushi Miki, Naohiro Sata, Yoshikazu Yasuda, Department of Surgery, Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan
Author contributions: Sanada Y contributed to study design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript; Sasanuma H, Miki A, Katano T, Hirata Y, Okada N, Yamada N, Ihara Y and Urahashi T contributed to acquisition of data, and analysis and interpretation of data; Sakuma Y, Sata N, Yasuda Y and Mizuta K contributed to analysis and interpretation of data, and critical revision of the manuscript for important intellectual content; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committees of Jichi Medical University (15-106).
Informed consent statement: The patient involved in this study gave her informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: We declare that we have no conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yukihiro Sanada, MD, PhD, Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan. yuki371@jichi.ac.jp
Telephone: +81-285-587069 Fax: +81-285-587069
Received: April 2, 2016
Peer-review started: April 7, 2016
First decision: May 30, 2016
Revised: June 11, 2016
Accepted: July 6, 2016
Article in press: July 6, 2016
Published online: September 14, 2016
Processing time: 158 Days and 21 Hours
Abstract

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.

Keywords: Opened round ligament; Venous patch graft; Hepatic venous reconstruction; Living donor liver transplantation; All-in-one venoplasty

Core tip: 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 pathological analysis of an opened round ligament used as a venous patch graft in living donor liver transplantation. The hepatic venous (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.