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Urgent living-related liver transplantation using a graft with multiple intrahepatic arterioportal fistulae
Y Hashikura1, S Kawasaki, S Miyagawa
1First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Insights
A father with asymptomatic intrahepatic arterioportal fistulae successfully donated a liver segment to his son. This living donor liver transplant for severe acute hepatitis B was uneventful for both.
Area of Science:
- Hepatology
- Transplant Surgery
- Vascular Surgery
Background:
- A pediatric patient presented with severe acute hepatitis B, necessitating a liver transplant.
- The father was identified as a potential living donor for his son.
Observation:
- Preoperative evaluation revealed intrahepatic arterioportal fistulae in the donor's left lobe.
- Duplex ultrasonography confirmed normograde portal blood flow despite the fistulae.
Findings:
- A living-related liver transplantation was successfully performed using the left lateral segment.
- Both donor and recipient experienced an uneventful postoperative recovery.
- The recipient remained free of recurrent hepatitis B and maintained normograde portal blood flow.
Implications:
- Intrahepatic arterioportal fistulae may exist asymptomatically, potentially impacting portal blood flow.
- Duplex ultrasonography is a valuable tool for assessing living liver donors with vascular anomalies.
- This case highlights the feasibility of living donor liver transplantation even with pre-existing arterioportal fistulae.
Background:
We describe the case of a man with intrahepatic arterioportal fistulae located in the left lobe, whose left lateral segment was transplanted into his son who was suffering from severe acute hepatitis B.
Methods:
A male infant with severe acute hepatitis B was considered to be a candidate for liver transplantation. The father was willing to be the donor. Preoperative evaluation of the donor revealed intrahepatic arterioportal fistulae, however, duplex ultrasonography showed normograde portal blood flow. A living-related liver transplantation was performed.
Results:
The postoperative course for both the donor and recipient was uneventful. The recipient is free of recurrent hepatitis B and has normograde portal blood flow.
Conclusions:
The present case suggests that there may be a symptomless population with intrahepatic arterioportal fistulae, which cause various degrees of disruption of the portal blood flow. Duplex ultrasonography might be helpful in the evaluation of candidates for liver donation.