Tailored standardization of portal vein reconstruction for pediatric liver transplantation at Asan Medical Center

Ahn

et al. 2022

Korean J Transplant

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Background:The outcomes of liver transplantation (LT) have improved, but actual 20year survival data have rarely been presented. Methods: Longitudinal follow-up data of 20-year LT survivors were retrospectively analyzed. The LT database of our institution was searched to identify patients who underwent primary LT from January 2000 to December 2001. The study cohort of 251 patients was divided into three groups: 207 adults who underwent living donor LT (LDLT), 22 adults who underwent deceased donor LT (DDLT), and 22 pediatric patients who underwent LT. Results: Hepatitis B virus-associated liver cirrhosis and biliary atresia were the most common indications for adult and pediatric LT, respectively. Seven patients required retransplantation, including six who underwent DDLT and one who underwent LDLT. Twenty-two patients died within 3 months after LT and 69 died at later intervals. The overall survival rates at 1

Section: Discussionmentioning

confidence: 99%

Twenty-year longitudinal follow-up after liver transplantation: a single-center experience with 251 consecutive patients

Kim

Ahn

et al. 2022

Korean J Transplant

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“…Most PV-associated complications resulted from inadequacy of the recipient PV, such as hypoplastic PV in patients with biliary atresia [3,4]. Thus, recipient PV venoplasty has been a matter of concern [5,6].…”

Section: Discussionmentioning

confidence: 99%

Wedged-patch venoplasty for graft left portal vein in pediatric living donor liver transplantation

Namgoong

et al. 2021

Ann Liver Transplant

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Portal vein (PV)-size matching is important in preventing anastomotic stenosis in liver transplantation (LT) using a partial liver graft. Reconstruction of small graft PV with size-unmatched recipient PV is challenging, thus we present our surgical technique of wedged-patch venoplasty to enlarge the diameter of graft PV for sizematched reconstruction. On computational simulation, a longitudinal incision was made at the graft PV stump and then a small triangular homograft vein patch was attached. Our simulation showed that a 5-mm incision combined with patch venoplasty could make the diameter of graft PV 30%-50% larger than the native size. We applied this technique to two pediatric patients. The first case was a 4-yearold female patient who underwent second LT because of progressive deterioration of graft function. At the first LDLT operation for biliary atresia, an iliac vein conduit was interposed for PV reconstruction. At the second LT operation, the diameter of interposed PV was 10 mm, but the left liver graft PV was only 7 mm in diameter because of congenital waist. The second case was an 8-year-old female patient who underwent split LT because of intractable recurrent cholangitis following resection of choledochal cyst. The graft PV was small because of type III PV anomaly of the donor liver. We performed wedged venoplasty using an iliac vein homograft patch in these two cases, and no PV complication occurred. In conclusion, our wedgedpatch venoplasty technique can be applied to small graft PV to cope with PV-size mismatching in LT using a partial liver graft.

Usability of intraoperative cine‐portogram during liver transplantation in young pediatric patients with biliary atresia

Namgoong

Pediatric Transplantation

et al. 2021

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Background Pediatric patients with biliary atresia (BA) often present liver cirrhosis‐associated portal hypertension and portal vein (PV) hypoplasia. For successful liver transplantation (LT), it is essential to maintain sufficient PV inflow through stenosis‐free PV reconstruction with effective ligation of collateral veins. The aim of this study was to assess the clinical usability of intraoperative cine‐portogram (IOCP) in young pediatric patients who underwent LT for BA. Methods Medical records of pediatric patients younger than 10 years who underwent primary LT for BA from 2018 to 2020 were reviewed. Results A total of 31 patients had undergone Kasai portoenterostomy soon after birth. Their median ages at Kasai portoenterostomy and LT were 1 and 11 months, respectively. Types of LT were living‐donor LT in 13, deceased‐donor split LT in 15, and deceased‐donor whole LT in three patients. PV interposition using an iliac vein homograft was performed in 28 patients receiving partial liver grafts. Side‐to‐side PV unification venoplasty was performed in three patients undergoing whole LT. All patients underwent ligation of collateral veins. IOCP was performed in 6 (19.4%) patients. Four showed no or faint residual venous collaterals. Collateral vein embolization and endovascular stenting were performed in one patient each. PV insufficiency‐free survival rate was 100% at 1 year and 93.8% at 3 years. All patients are currently alive with a median follow‐up period of 23 months. Conclusions Intraoperative cine‐portogram can be a useful method for identification and embolization of residual portosystemic collateral veins in young pediatric patients who undergo LT for biliary atresia.