Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation

Background. Portal vein reconstruction is a crucial factor affecting the ou tcome of a successful living-related liver transplantation. We describe her e our experience with portal vein reconstruction in 314 cases of living-rel ated liver transplantation with use of novel surgical modalities to enable the transplant surgeons to deal with any size mismatch between the donor's and recipient's portal veins. Methods. Portal vein reconstruction was classified into 2 major groups, ana stomosis without and with a vein graft. When there was no stenosis of the r ecipient portal vein and the diameter was the same, the portal trunk was us ed for anastomosis. When the diameter mismatch was minimal, branch patch an astomosis was feasible. When the recipient portal vein was significantly st enotic and the portal vein of the graft was long enough, we removed the ste notic trunk and constructed an anastomosis between the graft portal vein an n the confluence of the recipient portal vein. When the graft portal vein w as short, a vein graft was interposed. The vein patch technique was prefera ble when the diameter of the graft vein was not large enough for the interp osition technique. Results. Anastomosis without vein graft included trunk anastomosis (n = 156 ), branch patch anastomosis (n = 39), and confluence anastomosis (n = 22). Anastomosis with vein graft used the interposition technique (n = 77) and v ein patch technique (n = 27). The origin of the grafts was mostly from the maternal left ovarian vein (70 %) or the paternal inferior mesenteric vein (27%). Complications related to portal vein reconstruction occurred in 16 ( 5%) patients: portal vein thrombosis in 8, stenosis in 7 and fatal rupture in 1 patient. The incidence of complications was similar for all techniques except for confluence anastomosis. Conclusion. Our innovative techniques should be helpful for overcoming diam eter or length mismatches in portal vein reconstruction in pediatric liver transplantation.