Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2020; 8(3): 568-576
Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.568
Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report
Jiang Li, Qing-Jun Guo, Wen-Tao Jiang, Hong Zheng, Zhong-Yang Shen
Jiang Li, Qing-Jun Guo, Wen-Tao Jiang, Hong Zheng, Zhong-Yang Shen, Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Zheng H, Guo QJ, and Shen ZY performed transplant surgery and provided the intellectual content; Li J performed the literature review, summarized the clinical data, and drafted the manuscript; Jiang WT contributed critical comments and revised the manuscript; all authors read and approved the final manuscript.
Informed consent statement: The patient gave his written informed consent to this case report.
Conflict-of-interest statement: We declare that we have no financial or personal relationships with other people or organizations that can inappropriately influence our work. There is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Corresponding author: Jiang Li, MD, PhD, Associate Professor, Surgeon, Department of Liver Transplant, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin 300192, China. lijiang_009@163.com
Received: November 12, 2019
Peer-review started: November 12, 2019
First decision: December 12, 2019
Revised: December 31, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: February 6, 2020
Processing time: 85 Days and 16.9 Hours
Abstract
BACKGROUND

Loss of graft function after liver transplantation (LT) inevitably requires liver retransplant. Retransplantation of the liver (ReLT) remains controversial because of inferior outcomes compared with the primary orthotopic LT (OLT). Meanwhile, if accompanied by vascular complications such as arterial and portal vein (PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center's experience in ReLT through a complicated case of ReLT.

CASE SUMMARY

We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful. Four months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years. The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation.

CONCLUSION

With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.

Keywords: Liver retransplantation; Biliary tract complication; Ischemic type biliary lesion; Portal vein thrombosis; Arterial occlusion; Graft liver failure; Case report

Core tip: We report the case of a patient who underwent retransplantation for graft liver failure due to a biliary complication after liver transplantation. The portal vein (PV) thrombosis and hepatic artery occlusion posed great challenges for surgery. The operation was performed in a classic orthotopic liver transplantation manner without venous bypass. Because the blood flow of the PV was not ideal after removing the thrombosis, the graft PV was anastomosed with the recipient’s left renal vein. The hepatic artery was anastomosed with the abdominal aorta. Biliary anastomosis was performed in an end-to-end manner. The patient was discharged from hospital with normal liver and kidney function.