Portal Vein Reconstruction in Pediatric Liver Transplantation From Living Donors

Abstract

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.

Early vascular complications after pediatric liver transplantation

“…†Blood loss index ϭ blood loss in liters/circulating blood volume of the child. 18 on days 1, 3, and 7 after transplantation and when clinically deemed necessary. In all cases, the diagnoses of HAT, PVT, or VOTO were confirmed by angiography, cavography, or surgery.…”

“…Moreover, children with biliary atresia are at increased risk for portal vein complications because of the poor quality or absence of the portal vein as a result of sclerosis by cholangitis or previous surgery. 18 Greater D/R age and weight ratios often result in a difference in caliber between a relatively small recipient portal vein and larger donor portal vein, increasing the risk for PVT. 6,19 Because the difference in caliber of donor and recipient portal veins is more marked using left-segmental grafts, it has led to an increased occurrence of PVT in this type of transplantation.…”

Surgical complications and outcome of paediatric liver transplantation: the Singapore experience

“…All the six children were aged less than 2 years and five of the six cases of PVT occurred in children with biliary atresia. Children with biliary atresia are at an increased risk from PV complications because of the poor quality or absence of the PV as a result of sclerosis by cholangitis or previous surgery [19]. One patient with HV thrombosis in our series was successfully retransplanted and is live and well.…”

No‐Touch Hepatic Hilum Technique to Treat Early Portal Vein Thrombosis After Pediatric Liver Transplantation

“…Alternatively, percutaneous transhepatic balloon angioplasty has been used successfully to treat some patients with PV stenosis or thrombosis (5)(6)(7)(8)(9). However, in the early postoperative course, the role of this procedure is controversial since patients have a high risk of developing complications such as hemorrhage (6) (1,4,10,12,13). Different surgical strategies have been developed to reduce the incidence of PVT and overcome differences in vessel diameter between the graft and recipient PV, particularly in PV hypoplasia (1,4,10,11 …”