Portal vein reconstruction using vein grafts in pediatric living donor liver transplantation: Current status

Abstract

PV reconstruction is an important aspect of LDLT, with post-transplant outcomes depending on PV reconstruction methods. However, it is unclear whether the preferential selection of these techniques is dependent on preoperative recipient characteristics. This retrospective study assessed whether preoperative recipient factors differed in pediatric patients who did and did not receive VGs for PV reconstruction. Of 113 pediatric patients who underwent LDLT from January 2010 to July 2015, 31 (27%) underwent PV reconstruction with VGs and the other 82 (73%) without VGs. The presence of collateral vessels (P<.0001) and ascites (P=.02); PV size (P<.001), thrombosis (P=.01) and the direction of flow (P=.01), Child-Pugh class A vs B/C liver function (P=.01), Alb concentration (P=.02), primary diagnosis: BA vs non-BA (P=.03), and previous abdominal surgery (P<.005) differed significantly in patients who did and did not receive VGs for PV reconstruction. PV complications, patient survival, and graft survival did not differ significantly in patients with and without VGs at 1-year follow-up. VGs should be harvested for recipients with pretransplant hypoplastic PV, intense collaterals, hepatofugal flow, poor liver status, or previous abdominal surgery.

Biliary reconstruction before clamp removal to avoid portal vein thrombosis in pediatric living‐donor liver transplantation using hyper‐reduced left lateral segment grafts: A novel technical strategy

“…It can be as serious as thrombosis of the HA, causing graft failure and the need for surgical or radiological intervention, or even re‐transplantation. As reported by Sieders et al, up to 70% of patients with PV complications (stenosis, thrombosis) suffered graft loss and death …”

“…As reported by Sieders et al, up to 70% of patients with PV complications (stenosis, thrombosis) suffered graft loss and death. [18][19][20] Shehata et al 21 As we have described our implantation technique in a previous report in 2013, 10 we were based on the idea that to achieve early revascularization, it would seem logical to mimic in LDLT the anastomotic sequence of full-sized liver transplants. However, as we had a PVT rate of 15% on that series, we have continued looking for new strategies in order to improve results.…”

Thrombosis prophylaxis in pediatric liver transplantation: A systematic review

“…Most studies reported a total incidence (early and late) of thrombosis. The incidence of PVT varies from 2% to 10% in pediatric living donor liver transplantation (LDLT)[ 37 , 39 ] and from 33% in pediatric LDLT to 4% in pediatric deceased donor liver transplantation (DDLT) with reduced graft[ 33 ]. HAT is presented mostly in mixed LDLT and DDLT pediatric population; incidence of HAT varies from 0% to 29%[ 31 , 32 , 34 - 36 , 38 ].…”

“…Most of the studies used Doppler ultrasonography (US) as a first line diagnostic screening for thrombosis[ 32 , 33 , 35 - 39 ]; frequency and duration of the screening is quite variable. Confirmation of the thrombosis detected by a second level diagnostic test, such as computer CT angiography, surgery or other methods is rarely specified[ 31 - 33 , 37 , 38 ].…”

“…Table 1 summarizes the main results of the studies analyzed. In LDLT there are four different modalities to perform portal vein anastomosis: (1) standard reconstruction with end to end anastomosis[ 37 , 39 ]; (2) reconstruction with anastomosis to the bifurcation of the recipient left and right vein[ 39 ]; (3) reconstruction with anastomosis to the confluence of the recipient mesenteric vein[ 39 ]; and (4) reconstruction with an interposition of vein graft[ 33 , 37 , 39 ]. The overall results of different techniques were similar.…”