Nikeghbalian S, Kazemi K, Salahi H, Bahador A, Davari H R, Jalaeian H, Rasekhi A R, Nejatollahi S M R, Gholami S, Malek-Hosseini S A
Shiraz Organ Transplantation Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Transplant Proc. 2007 Jun;39(5):1691-2. doi: 10.1016/j.transproceed.2006.12.040.
The use of extended criteria liver donors has become a necessity in an era of organ scarcity for transplantation. We present here a case report of orthotopic liver transplantation using a liver with a giant right lobe hemangioma without backtable resection.
There were no data regarding the liver mass before organ procurement. The donor liver function tests and electrolyte profile were normal. During donor exploration a hemangioma was identified in segments V-VI, occupying approximately 20% of the total liver volume. It was prepared for transplantation on a sterile backtable without performing backtable hemangioma resection. A standard orthotropic liver transplant procedure was performed uneventfully, without veno-veno bypass. There was no bleeding from the hemangioma. The ischemic time was 9 hours and 20 minutes. Postoperative course was uneventful and the patient was discharged at 19 days after the operation. The hemangiomas showed evolution with some decrease in size upon later follow-ups. No clinically important complication was observed.
Our case and other previous reports show that even large hemangiomas should not be considered to be a contraindication to organ procurement. These benign lesions either could be left in situ and observed or resected.
在器官移植供体稀缺的时代,使用扩大标准肝脏供体已成为必要。我们在此呈现一例原位肝移植病例报告,供肝带有巨大右叶血管瘤且未在体外进行切除。
在获取器官前没有关于肝脏肿物的数据。供肝功能检查和电解质指标正常。在供体探查过程中,在Ⅴ-Ⅵ段发现一个血管瘤,约占肝脏总体积的20%。在无菌体外操作台上准备进行移植,未进行体外血管瘤切除。顺利进行了标准的原位肝移植手术,未使用静脉-静脉转流。血管瘤未出血。缺血时间为9小时20分钟。术后过程顺利,患者于术后19天出院。后续随访中血管瘤有变化,体积有所减小。未观察到具有临床重要意义的并发症。
我们的病例及其他既往报告表明,即使是大的血管瘤也不应被视为器官获取的禁忌证。这些良性病变既可以留在原位观察,也可以切除。