Matsubara Kentaro, Fujimoto Yasuhiro, Kamei Hideya, Ogawa Kohei, Kasahara Mureo, Ueda Mikiko, Egawa Hiroto, Takada Yasutsugu, Kitajama Masaki, Tanaka Koichi
Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan.
Liver Transpl. 2005 Nov;11(11):1444-7. doi: 10.1002/lt.20584.
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.
活体肝移植(LDLT)已成为治疗儿童终末期肝病的成熟技术。胆道闭锁(BA)是儿童肝移植最常见的适应证之一,可伴有内脏反位(SI)。过去,由于技术困难,SI的存在被认为是肝移植的绝对禁忌证。最近,已有一些关于BA合并SI患者进行病肝移植成功的报道;然而,关于LDLT的报道很少。此类病例LDLT所涉及的技术困难尚未见描述。在此,我们报告4例BA合并SI患者LDLT成功的病例。与SI相关的复杂异常,如腹腔干上方主动脉发出的肝动脉、十二指肠前门静脉以及肝后下腔静脉缺如,增加了手术的技术难度。LDLT需要格外小心,因为活体供肝的血管短,且供体血管移植物的可用性有限。总之,通过技术改进和严格关注,BA合并SI的LDLT可以成功实施。本系列代表了报道的接受成功LDLT手术的BA合并SI患者的最大群体。