Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report

Figure 1 Preoperative abdominal imaging of the patient. A: From the 5^th year after primary liver transplantation, abdominal enhanced computed tomography showed portal vein thrombosis with cavernous degeneration of the portal vein (red arrow); B: Abdominal enhanced computed tomography showed portal vein thrombosis with occlusion of the hepatic artery (red arrow).

Figure 2 Preoperative abdominal imaging suggests a significant spleno-renal shunt (red arrow).

Figure 3 Images of liver retransplantation during operation. A: Graft portal vein was anastomosed to the recipient’s left renal vein using a free iliac vein graft in an end-to-end manner; B and C: Graft hepatic celiac artery was connected to the recipient’s abdominal aorta by the external iliac artery; D: Intraoperative image before abdominal closure.

Figure 4 Schematic diagram of surgical procedure. Liver vena cava anastomosis was performed in an orthotopic cavo-caval manner; portal reconstruction was carried out by means of end-to-end anastomosis; graft portal vein was connected with the recipient’s left renal vein through an interposition vein, and the distal end of the left renal vein was sutured; the hepatic artery anastomosis was done between the donor celiac artery and the recipient’s infrarenal aorta through an interposition artery; and a bilio-biliary anastomosis was performed with a T-shaped drainage tube.

Figure 5 Changes of portal vein blood flow during and after retransplantation of the liver.

Figure 6 Renal function (serum creatinine) changes after retransplantation of the liver.

Figure 7 Preoperative and postoperative liver function in the patient with retransplantation of the liver.