Feasibility of Liver Transplantation with Preservation of the Inferior Vena Cava and without Veno-Venous Bypass Use in Adult Polycystic Liver Disease

Darius, Tom [UCL] Ciccarelli, Olga [UCL] Hassoun, Ziad [UCL] De Reyck,C Roggen, F Lerut, Jan [UCL]

Introduction: Massive handicapping hepatomegaly due to adult polycystic liver disease (PLD) is accepted as indication for Liver Transplantation (LT). In the early series, outcome was poor because of high morbidity and/or mortality related to technical difficulties of the hepatectomy. We reviewed our surgical experience performing a hepatectomy with Inferior Vena Cava (IVC) preservation and without the use of Veno-venous Bypass (VVB) and long term outcome. Methods: Between 1999 and 2010, 21 patients underwent LT for PLD. Median age was 50 years (range, 28-68). 5 patients with isolated PLD (no renal disease) received LT alone. 7 of the 21 patients (33%) had previous extensive surgical fenestrations of the liver cysts. Of 16 patients with combined PLD and Autosomal Dominant Polycystic Kidney Disease, 13 underwent isolated LT and 3 received a combined liver and kidney transplantation.Tacrolimus monotherapy and triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil and steroids) were given respectively after isolated LT and combined liver and kidney transplantation. The median follow up was 61 months (range, 17-147). Results: IVC sparing hepatectomy without the use of VVB could be realized uncomplicated in all patients. In patients with previous liver surgery, hepatectomy was much more difficult and surgical time was significantly longer (p=0.032). However, total blood transfusion and transfusion of Stable Solution of Plasma Protein were comparable between the 2 groups (p=0.952 and p=0.627). The allograft was routinely implanted using a large latero-lateral cavoplasty during partial IVC clamping. The 1 and 5-year patient and graft survival rates were 100% and 100% and 95% and 90%, respectively. Hepatic artery thrombosis and diffuse (ischemic type) intrahepatic biliary strictures were the causes of graft failure, respectively 3 days and 42 months after LT. Conclusion: LT for PLD can only be justified if transplant surgery can be done without major morbidity and no mortality and if long-term outcome is excellent. Our experience in a small patient cohort confirms that LT technique based on surgical anatomy and anatomical surgery allows to obtain excellent results. Previous liver cyst surgery is usually unsuccessful at long term and it also seriously compromises the transplant procedure.