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Liver Autotransplantation from the Labs to the Ante-situm Procedure: A Long Journey

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Contemporary Liver Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

The use of liver transplantation techniques, including interventional radiology techniques, complete liver vascular control, and liver preservation technique, has contributed to current management of patients with involvement of the inferior vena cava by hepatic tumors or those with large centrally located lesions or lesions in close proximity to the confluence of the inferior vena cava and hepatic veins, which would otherwise be deemed unresectable.

The training of hepatobiliary surgeons must include a familiarity with all such techniques and formal training in liver transplantation. Appropriate decision-making for formal resections in patients who have been treated with systemic neoadjuvant therapies and then require subsequent surgical care is based on a mandatory evaluation of massive lobar or multilobar tumor involvement and intra- or retro-hepatic venous neoplastic lesions.

The transfer of the patient to a transplant center is the gold standard for centers that lack the surgical and medical expertise of transplant referral centers. Technical skills in advanced hepatobiliary surgery, patient hemodynamics and resuscitation, diagnostic multidisciplinary evaluations, operative indications by grade of tumor extension, selection criteria for surgical management, and criteria for the choice of operation are mandatory for indicating formal liver resection as initial therapy and/or excision of tumors of the caval confluence and/or all three hepatic veins.

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Abbreviations

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

HVE:

Hepatic vascular exclusion

ISMETT:

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (Mediterranean Institute for Transplantation and Advanced Specialized Therapies)

IVC:

Inferior vena cava

IVCTT:

Inferior vena cava tumor thrombus

MRI:

Magnetic resonance imaging

PCS:

Portacaval shunt

PTFE:

Polytetrafluoroethylene

UPMC:

University of Pittsburgh Medical Center

VVB:

Venovenous bypass

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Author information

Authors and Affiliations

  1. Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione – Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Sicily, Italy

    Salvatore Gruttadaria & Duilio Pagano

  2. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh School of Medicine, UPMC Montefiore, 7 South, 3459 Fifth Avenue, Pittsburgh, PA, 15213-2582, USA

    J. Wallis Marsh

Authors
  1. Salvatore Gruttadaria
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  2. Duilio Pagano
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  3. J. Wallis Marsh
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Corresponding author

Correspondence to Salvatore Gruttadaria .

Editor information

Editors and Affiliations

  1. Nicoletti Family Professor of Transplant Surgery, Director, Jefferson Transplant Institute, Director, Division of Transplantation, Surgical Director, Kimmel Cancer Center – Jefferson Liver Tumor Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

    Cataldo Doria

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Gruttadaria, S., Pagano, D., Marsh, J.W. (2017). Liver Autotransplantation from the Labs to the Ante-situm Procedure: A Long Journey. In: Doria, C. (eds) Contemporary Liver Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07209-8_30

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  • DOI: https://doi.org/10.1007/978-3-319-07209-8_30

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07208-1

  • Online ISBN: 978-3-319-07209-8

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