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

Abstract

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.

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

“…Namgoong JM et al Modified patch-conduit venoplasty best material for interposition vein conduits, but their time of availability is very limited during LT, even in patients undergoing split LT [2]. Although cryopreserved iliac veins can be used as alternative interposition vein conduits for PV reconstruction, various conduit-associated complications, including aneurysm, stricture, and thrombosis, have been reported [8][9][10]. Thus, interposition using a cryopreserved iliac vein is not recommended for PV reconstruction.…”