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HPB Surgery
Volume 2010, Article ID 828326, 4 pages
http://dx.doi.org/10.1155/2010/828326
Case Report

Life-Saving Super-Urgent Liver Transplantation with Replacement of Retrohepatic Vena Cava by Dacron Graft

1Department of Surgery, Liver Transplantation Unit, Niguarda “Cà Granda” Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
2Department of Genaral Surgery, Hepatobiliary and Transplant Unit, Niguarda “Cà Granda” Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy

Received 21 March 2010; Revised 31 May 2010; Accepted 26 June 2010

Academic Editor: Guntars Pupelis

Copyright © 2010 Paolo Aseni et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe a modified technique of side-to-side cavo-cavostomy by Dacron interposition prosthesis during a super urgent liver transplantation. A liver graft from a deceased donor was immediately requested on a top priority basis as a consequence of massive bleeding during extended left hepatectomy for a huge hepatic haemangioma arising from the caudate lobe. Veno-venous bypass was employed during anhepatic phase but it was disconnected due to severe fibrinolysis and hypothermia. A porto-caval shunt was performed and the inferior vena cava outflow was restored by a Dacron interposition prosthesis. A liver graft from a deceased donor was available 16 hours later. Due to the shortness of the vena cava of the donor liver graft, the removal of the Dacron graft was impossible and a modified side-to-side cavo-cavostomy between the Dacron interposition graft and the vena cava of the donor liver was than performed. Liver transplantation was uneventful and the patient is doing well 25 months after the surgical procedure. Although the use of synthetic vascular prosthesis should usually be discouraged during organ transplantation, its exceptional use during liver transplantation is possible with long-term good results.