Ann Surg 1998 Feb;227(2):275-81

Portal vein reconstruction in pediatric liver transplantation from living
donors

Saad S, Tanaka K, Inomata Y, Uemoto S, Ozaki N, Okajima H, Egawa H, Yamaoka Y

Second Department of Surgery, Kyoto University Faculty of Medicine, Japan.

Abstract

OBJECTIVE: The authors analyze the surgical pattern and the underlying rationale
for the use of different types of portal vein reconstruction in 110 pediatric
patients who underwent partial liver transplantation from living parental
donors. SUMMARY BACKGROUND DATA: In 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. METHODS: In 110 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 II); to the confluence of the recipient
superior mesenteric vein and the splenic vein (type III); 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. RESULTS: The portal vein of the liver graft was anastomosed by
reconstruction type I in 32%, II in 24%, III in 14%, and IV 29% of the cases. In
children <1 year of age, type I could be performed in only 17% of the cases,
whereas 37% received type IV reconstruction. Postoperative Doppler ultrasound
(mL/min/100 g liver) showed significantly (p < 0.05) lower portal blood flow
after type II (76.6 +/- 8.4) versus type I (110 +/- 14.3), type III (88 +/- 18),
and type IV (105 +/- 19.5). Portal vein thrombosis occurred in two cases after
type II and in one case after type IV anastomosis. Portal stenosis was
encountered in one case after type I reconstruction. Pathologic changes of the
recipient native portal vein were found in 27 of 35 investigated cases.
CONCLUSION: In living related partial liver transplantation, portal vein
anastomosis to the confluence with or without the use of vein grafts is the
optimal alternative to end-to-end reconstruction, especially in small children.