Portal vein reconstruction in high risk infantile liver transplantation

Abstract

Objective To explore the experience of infantile liver transplantation, reconstructing portal vein (PV) and avoid the higher incidence of portal vein low flow and complications. Methods The clinical data were reviewed for 152 infantile liver transplantations performed by a single surgery group. And 114 cases with PV risk factors underwent customized PV reconstructions. All of them were diagnosed as cholestatic liver diseases and 106 (93%) belonged to biliary atresia. Forty-two cases (36%) had 2 or more risk factors. Results Most cases (n=106, 93%) underwent living donor transplantations using lateral left graft while another 8 cases had deceased donor transplantations. Four types of PV reconstructions were adopted based upon individual conditions: left/right branch of PV trunk (n=103), autogenous patch PV venoplastic reconstruction (n=3), duct-to-duct of PV trunk (n=5) and donor PV duct-to-recipient confluence of SMV/CV and SV (n=3). Graft size reduction was performed when GRWR>4.5% (n=16). During a median follow-up period of 6.5 (1.5-13) months, there were 3 LPVF (2.6%), 2PVS (1.7%) and 1 PVT (0.8%). Three LPVF cases was corrected by PV stenting, two cases of PVS were stable after anticoagulation therapy while one PVT case undergoing thromboectomy plus PV stenting resumed a normal PV flow. Conclusions PV reconstruction of high-risk infants require comprehensive risk evaluations, precise surgical skills and customized strategies. For PV complications, stenting is both safe and feasible. Key words: Liver transplantation; Portal vein; Anastomosis, surgical