{"title":"新的门静脉重建策略对胆道闭锁儿童活体肝移植门静脉生长和预后的影响。","authors":"Hikaru Aoki, Eri Ogawa, Takashi Ito, Elena Yukie Uebayashi, Shinya Okumura, Yuki Masano, Tatsuya Okamoto, Hironori Haga, Hideaki Okajima, Etsuro Hatano","doi":"10.1002/jhbp.70003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/purpose: </strong>We evaluated the outcomes of a new reconstruction method that we adopted in 2017 for small children with biliary atresia, involving aggressive resection of the sclerotic portal vein (PV), larger anastomotic orifice, and proactive vein graft interposition.</p><p><strong>Methods: </strong>Data from 85 patients with biliary atresia (excluding one) aged < 3 years who underwent living-donor liver transplantation from January 2011 to December 2022 were retrospectively reviewed. Patients were categorized into former (\"before 2017\") and latter (\"after 2017\") groups, comprising 47 and 38 patients, respectively, according to their surgery time.</p><p><strong>Results: </strong>The percentage of trunk reconstruction cases decreased from 51% to 26%, whereas that of vein graft interposition cases increased from 38% to 68% (p = 0.021). PV complication rates improved significantly from 19% to 3% (p = 0.035). Over 6 months postoperatively, the PV diameter was < 6 mm in 44% of cases in the former group but improved to 0% in the latter group (p < 0.01). Platelet counts at 1 year postoperatively were significantly higher in the latter group.</p><p><strong>Conclusions: </strong>In living-donor liver transplantation for small children with biliary atresia, aggressive resection of the sclerotic PV, large anastomotic orifice, and proactive vein graft interposition may reduce PV complications and provide appropriate portal dilation for body growth.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of New Portal Reconstruction Strategy on Portal Vein Growth and Outcomes in Living-Donor Liver Transplantation for Small Children With Biliary Atresia.\",\"authors\":\"Hikaru Aoki, Eri Ogawa, Takashi Ito, Elena Yukie Uebayashi, Shinya Okumura, Yuki Masano, Tatsuya Okamoto, Hironori Haga, Hideaki Okajima, Etsuro Hatano\",\"doi\":\"10.1002/jhbp.70003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background/purpose: </strong>We evaluated the outcomes of a new reconstruction method that we adopted in 2017 for small children with biliary atresia, involving aggressive resection of the sclerotic portal vein (PV), larger anastomotic orifice, and proactive vein graft interposition.</p><p><strong>Methods: </strong>Data from 85 patients with biliary atresia (excluding one) aged < 3 years who underwent living-donor liver transplantation from January 2011 to December 2022 were retrospectively reviewed. Patients were categorized into former (\\\"before 2017\\\") and latter (\\\"after 2017\\\") groups, comprising 47 and 38 patients, respectively, according to their surgery time.</p><p><strong>Results: </strong>The percentage of trunk reconstruction cases decreased from 51% to 26%, whereas that of vein graft interposition cases increased from 38% to 68% (p = 0.021). PV complication rates improved significantly from 19% to 3% (p = 0.035). Over 6 months postoperatively, the PV diameter was < 6 mm in 44% of cases in the former group but improved to 0% in the latter group (p < 0.01). Platelet counts at 1 year postoperatively were significantly higher in the latter group.</p><p><strong>Conclusions: </strong>In living-donor liver transplantation for small children with biliary atresia, aggressive resection of the sclerotic PV, large anastomotic orifice, and proactive vein graft interposition may reduce PV complications and provide appropriate portal dilation for body growth.</p>\",\"PeriodicalId\":16056,\"journal\":{\"name\":\"Journal of Hepato‐Biliary‐Pancreatic Sciences\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-08-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hepato‐Biliary‐Pancreatic Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jhbp.70003\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hepato‐Biliary‐Pancreatic Sciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jhbp.70003","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Impact of New Portal Reconstruction Strategy on Portal Vein Growth and Outcomes in Living-Donor Liver Transplantation for Small Children With Biliary Atresia.
Background/purpose: We evaluated the outcomes of a new reconstruction method that we adopted in 2017 for small children with biliary atresia, involving aggressive resection of the sclerotic portal vein (PV), larger anastomotic orifice, and proactive vein graft interposition.
Methods: Data from 85 patients with biliary atresia (excluding one) aged < 3 years who underwent living-donor liver transplantation from January 2011 to December 2022 were retrospectively reviewed. Patients were categorized into former ("before 2017") and latter ("after 2017") groups, comprising 47 and 38 patients, respectively, according to their surgery time.
Results: The percentage of trunk reconstruction cases decreased from 51% to 26%, whereas that of vein graft interposition cases increased from 38% to 68% (p = 0.021). PV complication rates improved significantly from 19% to 3% (p = 0.035). Over 6 months postoperatively, the PV diameter was < 6 mm in 44% of cases in the former group but improved to 0% in the latter group (p < 0.01). Platelet counts at 1 year postoperatively were significantly higher in the latter group.
Conclusions: In living-donor liver transplantation for small children with biliary atresia, aggressive resection of the sclerotic PV, large anastomotic orifice, and proactive vein graft interposition may reduce PV complications and provide appropriate portal dilation for body growth.
期刊介绍:
The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.