No abstract

The goals of this study were to evaluate the incidence of hepatic venous outflow obstruction (HVOO) in pediatric patients after living donor liver transplantation (LDLT) using left-sided lobe grafts and to assess the therapeutic modalities used for the treatment of this complication at a single center. Four hundred thirteen primary LDLT procedures were performed with left-sided lobe grafts between 1996 and 2006. All transplants identified with HVOO from a cohort of 380 grafts with survival greater than 90 days were evaluated with respect to the patient demographics, therapeutic intervention, recurrence, and outcome. Seventeen cases (4.5%) were identified with HVOO. Eight patients experienced recurrence after the initial balloon venoplasty. Two patients finally required stent placement after they experienced recurrence shortly after the initial balloon venoplasty. A univariate analysis revealed that a smaller recipient-to-donor body weight ratio and the use of reduced grafts were statistically significant risk factors. The cases with grafts with multiple hepatic veins had a higher incidence of HVOO. In conclusion, the necessity of repeated balloon venoplasty and stent placement was related to poor graft survival. Therefore, the prevention of HVOO should be a high priority in LDLT. When grafts with multiple hepatic veins and/or significant donor-recipient size mismatching are encountered, the use of a patch graft is recommended. Stent placement should be carefully considered because of the absence of data on the long-term patency of stents and stent-related complications. New stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO. Liver Transpl 16:1207-1214, 2010. V C 2010 AASLD.Received April 5, 2010; accepted July 2, 2010.Techniques for reduced size liver transplantation, split liver transplantation, and living donor liver transplantation (LDLT) have been developed to address the shortage of organs and the size discrepancy between donors and recipients. 1,2 These types of liver transplantation are technically demanding because of the use of short vascular pedicles, which are more likely to cause postoperative vascular complications. Hepatic venous outflow obstruction (HVOO) is a rare vascular complication; however, it may lead to graft dysfunction without appropriate management. 3,4 The causes of HVOO include technical problems, subsequent fibrosis with inflammatory processes, and compression or twisting of the anastomosis caused by Abbreviations: BA, biliary atresia; GRWR, graft-to-recipient weight ratio; HVOO, hepatic venous outflow obstruction; IVC, inferior vena cava; LDLT, living donor liver transplantation; LL, left lobe; LLS, left lateral segment; r-LLS, reduced left lateral segment; SD, standard deviation; WD, Wilson's disease.

ObjectiveThe authors analyze the surgical pattern and the underlying rationale for the use of different types of portal vein reconstruction in 1 10 pediatric patients who underwent partial liver transplantation from living parental donors. Summary Background DataIn partial liver transplantation, standard end-to-end portal vein anastomosis is often difficult because of either size mismatch between the graft and the recipient portal vein or impaired vein quality of the recipient. Alternative surgical anastomosis techniques are necessary. MethodsIn 1 10 patients age 3 months to 17 years, four different types of portal vein reconstruction were performed. The portal vein of the liver graft was anastomosed end to end (type I); to the branch patch of the left and right portal vein of the recipient (type 11); to the confluence of the recipient superior mesenteric vein and the splenic vein (type 111); and to a vein graft interposed between the confluence and the liver graft (type IV). Reconstruction patterns were evaluated by their frequency of use among different age groups of recipients, postoperative portal vein blood flow, and postoperative complication rate.