Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):301-304. 10.14701/ahbps.2020.24.3.301.

Side-to-side portal vein reconstruction for infant-to-infant deceased donor whole liver transplantation: Report of 2 cases with video

• Namgoong JM
• Hwang S
• Ahn CS
• Jung DH
• Park GC

• KMID: 2505342
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.301

Abstract

Infant-to-infant whole liver transplantation (I2I-WLT) has been rarely performed in Korea. Unlike living donor liver transplantation or split liver transplantation, the donor graft portal vein (PV) in I2I-WLT is very small in diameter, so risk of PV complications increases significantly. We present two cases of I2I-WLT with application of side-to-side unification venoplasty for secure PV reconstruction. The first case recipient was a 10-month-old female baby who weighed 6.0 kg. She was diagnosed with progressive familial intrahepatic cholestasis. The deceased donor was a 12-month-old boy. The graft weight was 245 g, so the graft-recipient weight ratio (GRWR) was 4.1%. PV was reconstructed using side-to-side unification venoplasty. The function of graft liver recovered uneventfully and there was no evidence of PV complications. She is currently doing well for 4 years. The second case recipient was a 10-month-old female baby who weighed 8.8 kg. She had also undergone Kasai operation for biliary atresia. GRWR was 6.0%. Because the graft liver was much larger than the native liver, we designed the length of the extrahepatic PV more redundant than the precedent cases to avoid extrinsic compression by the large-sized caudate lobe. The PV was reconstructed using side-to-side unification venoplasty. The function of the graft liver recovered uneventfully. There was no evidence of PV complications. She is currently doing well for 2 years. As the PV size in infant donors and recipients is very small,PV reconstruction in I2I-WLT requires specialized surgical techniques of side-to-side unification venoplasty. Three supplementary video clips are provided.

Keyword

Complication; Portal vein; Pediatric transplantation; Deceased donor; Venoplasty

Figure

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  Illustration of the side-to-side unification technique used for portal vein (PV) reconstruction. A deep longitudinal incision was made at the “6 o’clock” direction of the graft PV and the “12 o’clock” direction of the recipient PV. Running sutures were then used to unify these two PVs. This technique creates an enlarged conduit from the superior mesenteric vein–splenic vein confluence to the hilar PV confluence.

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  Imaging findings of PV reconstruction using the side-to- side unification technique in the Case 1. The ventral surface of the whole liver graft was visible (A). A pretransplant computed tomography (CT) shows recipient’s portal vein anatomy (B). An intraoperative photograph shows completed PV reconstruction just after portal reperfusion (C). CT scan taken at posttransplant day 7 shows no evidence of PV complication (D).

• 

  Imaging findings of PV reconstruction using the side-to- side unification technique in Case 2. The ventral surface of the whole liver graft was visible with closure of the inferior stump of the vena cava (A). Redundant PV reconstruction with side-to-side unification technique was shown to avoid compression by the caudate lobe (B). Dynamic computed tomography scans were taken at posttransplant 5 days (C) and 1 year (D), showing no evidence of PV complication.

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