Impact of Pre-Transplant Liver Hemodynamics and Portal Reconstruction Techniques on Post-Transplant Portal Vein Complications in Pediatric Liver Transplantation

Abstract

PV hypoplasia with liver hemodynamic disturbances was mainly observed in BA. Hepatic ARI ≥1 might be a good predictor of PV complications post-LT. Latero-lateral portoplasty seemed to provide the best results when end-to-end anastomosis is not feasible.

Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

“…Liver transplantation in children younger than 1 year, however, shows an especially high risk of morbidity and mortality because of technical difficulties [3]. Especially in the infants with biliary atresia, PV hypoplasia with liver hemodynamic disturbances are often observed preoperatively because of recurrent cholangitis, which necessitates interposition vein graft reconstruction for uncompromised PV anastomosis at the time of LT [4]. We herein report 34 cases of our experience of LDLT for biliary atresia in infants younger than 1 year with PV hypoplasia.…”

Living Donor Liver Transplantation in Children

“…In case of PV hypoplasia, which was defined as PV diameter of 4 mm or less, further dissection of the SMV at the mesenteric pedicle was carried out to prepare the implantation of a venous jump graft in 30 cases (12%), allowing portal revascularization of the transplant. 6 More recently, the dissection was extended downward to the confluence of the splenic vein and SMV for lateral portoplasty with donor inferior mesenteric vein (IMV) performed in 51 cases (20%). The lateral portoplasty, as shown in Figure 2, consisted in opening longitudinally the anterior wall of the recipient's PV and suturing the donor IMV patch to the recipient's PV with a side-to-side anastomosis using 7/0 absorbable monofilament running sutures to enlarge the PV diameter.…”

“…Thereafter, anastomosis between this reconstructed recipient's PV and the graft portal stump was performed as a classical trunk anastomosis. 6 In cases without portal hypoplasia, PV anastomosis was performed in an end-to-end fashion between the graft left PVand the main portal trunk of the recipient. In cases of PV hypoplasia (n ¼ 81), a vascular interposition graft was used for the reconstruction of portal flow in the initial 30 cases, with these grafts being distributed as follows: preserved iliac vein grafts recovered from deceased donors (n ¼ 20, including 2 from ABO-incompatible donors, maximal preservation time of 14 days), recipient IJV (n ¼ 9), and an LD IMV (n ¼ 1).…”

“…In the remaining more recent 51 cases, laterolateral portoplasty was carried out using donor IMV graft. 6 The arterial anastomosis was carried out as end-to-end anastomosis between the graft left HA and the recipient HA, using magnifying loupes (Â5.5) and interrupted 8/0 Prolene (Ethicon Ltd, Edinburgh, United Kingdom) sutures according to a semimicrosurgical technique in 249 cases and in 1 early case performed under surgical microscope Â10 with 9/0 Prolene interrupted sutures. In 38 instances, the graft had 2 arteries.…”

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

“…[6][7][8][9] The following surgical characteristics were collected: total, cold, and warm (anastomosis) ischemia times; number of hepatic arteries in the graft; number of reconstructed hepatic arteries and number of ligated arteries in the graft; number of biliary anastomoses; site of the biliary anastomosis [common bile duct (CBD), common hepatic duct (CHD), or left hepatic duct (LHD)]; type of biliary reconstruction (hepaticojejunostomy, duct-to-duct anastomosis, or hepaticoduodenostomy); and type of abdominal wall closure (primary or secondary). Biliary reconstruction was most frequently performed with Roux-en-Y hepaticojejunostomy (n 5 396 or 92%) or a duct-to-duct anastomosis (n 5 22 or 5%) without the use of a biliary drain or stent.…”