Absence of the left portal vein: A difficulty for reduction of liver grafts?

Background. Absence of the portal bifurcation is exceptional and characteri zed by an absent extrahepatic portal vein bifurcation, the right portal vei n only being at the porta hepatis. There is no extraparenchymal left portal vein. This may represent a problem in liver splitting, reduction, and livi ng related transplantation. Method A case was encountered during reduction of a cadaveric liver allogra ft to a left lateral segmental graft from a 40-kg cadaveric donor to a 15-k g recipient. The portal venous inflow was reconstructed with a vein graft v ia a novel extrahilar approach to the left portal vein at the umbilical fis sure. Results. This graft was used successfully in a 3-year-old child requiring t ransplantation for a failed Kasai operation for extrahepatic biliary atresi a. The child is now well, 1 year posttransplant, after an uneventful postop erative course with good portal flow within the graft. Conclusion. The situation of an absent left portal vein extrahepatic course should not preclude splitting or reduction procedures. The innovative tech nical solution, we propose, should add to the armamentarium of the liver tr ansplant surgeon contemplating a left lateral segmental graft for the paedi atric liver transplant recipient.