Improved portal vein venoplasty with an autogenous patch in pediatric living donor liver transplantation

Feng, Min; Wan, Ping; Qiu, Bijun; Luo, Yi; Gu, Lihong; Chi, Jiachang; Zhong, Chengpeng; Lu, Yichao; Zhang, Jianjun; Xia, Qiang

doi:10.1002/lt.25011

Cited by 5 publications

(7 citation statements)

References 18 publications

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“…Although patch venoplasty for a stenotic PV is one of the standard techniques [ 1 , 19 ], it is necessary to evaluate its effectiveness. Many illustrations and intraoperative photographs have depicted the insertion of a narrow rectangular patch [ 1 ], but such a narrow patch can increase the PV diameter only by one-third of the patch width because it becomes a part of the PV circumference.…”

Section: Discussionmentioning

confidence: 99%

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Modified patch-conduit venoplasty for portal vein hypoplasia in pediatric liver transplantation

Namgoong,

Hwang,

Park

et al. 2023

Korean J Transplant

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Background Portal vein (PV) interposition can induce various PV-related complications, making more reliable techniques necessary. The present study describes the development of a modified patch venoplasty technique, combining the native PV wall and a vein homograft conduit, called modified patch-conduit venoplasty (MPCV). Methods The surgical technique for MPCV was optimized by simulation and applied to seven pediatric patients undergoing liver transplantation (LT) for biliary atresia combined with PV hypoplasia. Results The simulation study revealed that inserting the whole-length native PV wall as a longitudinal rectangular patch was more effective in preventing PV conduit stenosis than the conventional technique using triangular partial insertion. These findings were used to develop the MPCV technique, in which the native PV wall was converted into a long rectangular patch, acting as a backbone for PV reconstruction. A longitudinal incision on the vein conduit converted the cylindrical vein into a large vein patch. The wall of the native PV was fully preserved as the posterior wall of the PV conduit, thus preventing longitudinal redundancy and unwanted rotation of the reconstructed PV. This technique was applied to seven patients with biliary atresia undergoing living-donor and deceased-donor split LT. None of these patients has experienced PV complications for up to 12 months after transplantation. Conclusions This newly devised MCPV technique can replace conventional PV interposition. MCPV may be a surgical option for reliable PV reconstruction using fresh or cryopreserved vein homografts during pediatric LT.

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Section: Discussionmentioning

confidence: 99%

“…Vein allografts have been used in the present study. In contrast, a Chinese high-volume pediatric LT center presented a technique for autogenous PV patch plasty [ 19 ]. Vessel patches were procured from the left branch or the bifurcation of the right branch and left branch of the PV in the native liver.…”

Section: Discussionmentioning

confidence: 99%

Modified patch-conduit venoplasty for portal vein hypoplasia in pediatric liver transplantation

Namgoong,

Hwang,

Park

et al. 2023

Korean J Transplant

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“…Especially cryopreserved vascular grafts may result in portal vein complications in long term 15 . In addition, some authors suggested venoplasty to increase portal vein diameter 16,17 . During venoplasty, if sclerotic site is not resected, it might result in portal vein thrombosis 10 …”

Section: Discussionmentioning

confidence: 99%

“…15 In addition, some authors suggested venoplasty to increase portal vein diameter. 16,17 During venoplasty, if sclerotic site is not resected, it might result in portal vein thrombosis. 10 One of the limitations of this study is due to the fact that it is a retrospective analysis and the available data for analysis were limited.…”

Section: Discussionmentioning

confidence: 99%

Portal vein reconstruction with cryopreserved vascular grafts: A two‐edged sword

Sağlam

Sahin

Usta

et al. 2021

Pediatric Transplantation

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Background Portal vein anastomotic complications related to size discrepancy are important causes of morbidity and mortality in pediatric liver transplantation. Interposed vascular grafts in portal vein anastomosis can solve this problem. The aim of this study is to evaluate the results of pediatric liver transplantations performed using cryopreserved interposed vascular grafts between graft portal vein and superior mesenteric vein (SMV)‐splenic vein (SpV) confluence. Methods Twenty‐nine pediatric patients received liver transplantation using cryopreserved venous grafts in our Liver Transplant Institute between 2013 and 2020 were included in this study. Demographic, clinical, and operative characteristics and postoperative follow‐up were analyzed. Results Sixteen patients (55.2%) had portal hypoplasia and five patients (17.2%) had portal vein thrombosis. In total, six patients (20.6%) suffered portal vein thrombosis in the early postoperative period. Three patients (10.3%) experienced portal vein thrombosis in the late postoperative period. Late portal vein thrombosis rate was significantly higher in patients with early portal vein thrombosis (3/6 patients [50%] versus 0/23 patients [0%]; p = .034). Lack of portal flow was significantly higher in patients with both early (50% versus 0%; p = .002) and late portal vein thrombosis (66.7% versus 6.7%; p = .03). Conclusion Preoperative portal vein thrombosis and insufficient flow are important factors affecting success of liver transplant in children. The use of interposed vein grafts in problematic portal anastomoses can overcome portal flow problems.

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“…As for recipients, initial immunosuppressive therapy consisted of a dual drug regimen of tacrolimus combined with methylprednisolone. Doppler ultrasound (US) tests estimating the vascular system were performed daily in the first week after LT, every 2 days in the second week, monthly during the first 6 months, and every 3 months thereafter [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

Pediatric living-donor liver transplantation using right posterior segment grafts

Wan

Feng

et al. 2021

BMC Gastroenterol

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Background The right posterior segment (RPS) graft was introduced to overcome graft size discrepancy in living donor liver transplantation (LDLT). However, it was very rarely used in pediatric patients. Here we presented 4 pediatric LDLT cases receiving RPS graft between January 2015 and April 2020 in our center. A total of 1868 LDLT procedures were performed in this period. Methods Recipients included 1 boy and 3 girls with a median age of 45 months (range from 40 to 93 months). They were diagnosed with progressive familial intrahepatic cholestasis, propionic academia, ornithine transcarbamylase and biliary atresia, respectively. Four donors were all mothers with a median age of 32.5 years (31–38 years). Computer tomography angiography indicated posterior right branches branched off separately from main portal veins (type III variation). Three of these donor livers had 1 orifice of right hepatic veins (RHV). In the remaining 1 donor liver, the RHV showed 3 orifices and an outflow patch plastic was performed. Inferior right hepatic veins weren’t found in four donor grafts. The median graft weight was 397.5 g (352–461 g) and the median graft-to-recipient weight ratio was 2.38% (1.44–2.80%). Results Postoperative complications occurred in neither donors nor recipients. Within the median follow-up duration of 29 months (14–64 months), four children are all alive with normal liver function. Conclusion In summary, for older children weighed more than 15 kg with donors’ variation of type III portal veins, the use of RPS grafts could be a feasible and favorable option.

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Improved portal vein venoplasty with an autogenous patch in pediatric living donor liver transplantation

Cited by 5 publications

References 18 publications

Modified patch-conduit venoplasty for portal vein hypoplasia in pediatric liver transplantation

Modified patch-conduit venoplasty for portal vein hypoplasia in pediatric liver transplantation

Portal vein reconstruction with cryopreserved vascular grafts: A two‐edged sword

Pediatric living-donor liver transplantation using right posterior segment grafts

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