PORTAL-VEIN RECONSTRUCTION IN PEDIATRIC LIVER-TRANSPLANTATION FROM LIVING DONORS

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 r ecipient portal vein or impaired vein quality of the recipient. Altern ative surgical anastomosis techniques are necessary. Methods In 110 pa tients age 3 months to 17 years, four different types of portal vein r econstruction were performed. The portal vein of the liver graft was a nastomosed end to end (type I); to the branch patch of the left and ri ght portal vein of the recipient (type II); to the confluence of the r ecipient 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 port al 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 y ear of age, type I could be performed in only 17% of the cases, wherea s 37% received type IV reconstruction. Postoperative Doppler ultrasoun d (mL/min/100 g liver) showed significantly (p < 0.05) lower portal bl ood flow after type II (76.6 +/- 8.4) versus type I (110 +/- 14.3), ty pe II (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 anas tomosis. Portal stenosis was encountered in one case after type I reco nstruction. Pathologic changes of the recipient native portal vein wer e found in 27 of 35 investigated cases. Conclusion In living related p artial liver transplantation, portal vein anastomosis to the confluenc e with or without the use of vein grafts is the optimal alternative to end-to-end reconstruction, especially in small children.