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Living donor liver transplantation for biliary atresia complicated by situs inversus: technical highlights
Kentaro Matsubara1, Yasuhiro Fujimoto, Hideya Kamei
1Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan. m-ken@dk9.so-net.ne.jp
Insights
Living-donor liver transplantation (LDLT) is feasible for children with biliary atresia (BA) and situs inversus (SI). This study details successful LDLT in four pediatric patients, overcoming complex anatomical challenges.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Transplantation Medicine
Background:
- Living-donor liver transplantation (LDLT) is a vital treatment for pediatric end-stage liver disease.
- Biliary atresia (BA) is a common indication for pediatric liver transplantation.
- Situs inversus (SI) presents significant technical challenges in liver transplantation, historically considered a contraindication.
Purpose of the Study:
- To describe the technical aspects and outcomes of LDLT in pediatric patients with BA and SI.
- To highlight the feasibility of LDLT despite complex congenital anomalies associated with SI.
- To present the largest reported series of successful LDLT for BA with SI in children.
Main Methods:
- Retrospective analysis of four pediatric cases undergoing LDLT for BA with SI.
- Detailed description of surgical techniques and management of associated complex vascular and visceral anomalies.
- Focus on modifications required for LDLT due to limited graft vessel length and donor vascular graft availability.
Main Results:
- Successful LDLT was achieved in all four pediatric patients.
- Complex anomalies, including aberrant hepatic artery, preduodenal portal vein, and absent retrohepatic inferior vena cava, were successfully managed.
- No major intraoperative or postoperative complications directly related to SI were reported in this series.
Conclusions:
- LDLT for biliary atresia complicated by situs inversus is achievable with meticulous surgical planning and execution.
- Technical modifications and careful attention to anatomical variations are crucial for successful outcomes.
- This series demonstrates that LDLT can be a safe and effective option for pediatric patients with BA and SI, expanding treatment possibilities.
Abstract:
Living-donor liver transplantation (LDLT) has become an established technique to treat children with end-stage liver disease. Biliary atresia (BA), one of the most common indications for liver transplantation in children, can be associated with situs inversus (SI). In the past, the presence of SI has been considered to be an absolute contraindication for liver transplantation because of the technical difficulties. Recently, some reports of successful diseased-donor liver transplantation in patients with BA complicated by SI have been published; however, few reports of that with LDLT exist. The technical difficulties involved with LDLT for such cases have not been described. Herein, we present 4 successful cases of LDLT for BA with SI. Complex anomalies associated with SI, such as a hepatic artery arising from the supraceliac aorta, a preduodenal portal vein, and absence of the retrohepatic inferior vena cava, increase the technical difficulties involved with the operation. Additional caution is required in LDLT because a living-donor graft has short vessels and the availability of vascular grafts from the donor is limited. In conclusion, LDLT for BA complicated by SI can be managed successfully with technical modifications and scrupulous attention. This series represents the largest reported group of patients with BA complicated by SI who underwent a successful LDLT procedure.
