Use of the middle colic vein for liver cell transplantation in infants and small children

INTRODUCTION: Because it is less invasive, intraportal liver cell transplantation (LCT) is an interesting alternative to whole organ transplantation. The inferior mesenteric vein is usually chosen for portal vein access. However, anatomical variations are common in children, so we investigated catheter insertion into the middle colic vein. PATIENTS AND METHODS: Three children (3 weeks to 3 years; 3 to 14 kg) underwent LCT in our center for acute liver failure or severe neonatal urea cycle disorders. Small 4.2-French Hickman lines were surgically introduced into the middle colic vein and advanced to the portal vein stem. The patients received repetitive infusions of liver cells over a period of 4-11 days. RESULTS: Catheter insertion was feasible and tolerated well despite the poor clinical condition of 1 patient and the metabolic instability in the other 2 patients. Blood could be drawn from all catheters, and measurement of portal vein pressure was possible in 2 children. The patient with acute liver failure died after 11 days from complications of the underlying disease. In the other 2 children, portal vein catheters stayed patent for several months. CONCLUSIONS: The middle colic vein can be recommended for placement of intraportal LCT catheters even in small and critically ill infants.