Korean J Transplant.  2022 Nov;36(Supple 1):S295. 10.4285/ATW2022.F-4352.

End-to-side jump graft from superior mesenteric vein for portal vein reconstruction in pediatric liver transplantation: a case report

• Lee J
• Yi NJ
• Kim J
• Choi HH
• Lee S
• Hong SY
• Hong SK
• Choi Y
• Lee KW
• Suh KS

• KMID: 2535522
• DOI: http://doi.org/10.4285/ATW2022.F-4352

Abstract

Attenuated portal vein (PV) flow is challenging in pediatric liver transplantation (LT) because the PV size of a large-for-size graft is unsuitable even for an end-to-end jump vein graft from a small sized superior mesenteric vein (SMV). We introduce a novel technique of an end-to-side jump graft from the SMV for the patients with a large-for-size graft and attenuated portal flow during pediatric LT. In the first case, a 2-year-old male patient with hepatoblastoma had a Yerdel grade 3 PV thrombosis. He underwent a deceased split LT. The other patient is an 8-month-old female with biliary atresia and PV hypoplasia with stenosis on the confluence level of the SMV. Because her first liver graft was failed 9 days after deceased donor LT, emergency living donor LT from her father was planned. After hepatectomy, the PV was resected at the SMV confluence level. Then, an end-to-side reconstruction from the SMV to the interposition fresh iliac vein of a deceased donor was made for bridging to the graft left PV. The interposi-tion graft through posterior to the pancreas was obliquely anastomosed to the graft PV. There were no PV related complications during the follow-up period. In cases that a pediatric LT recipient has inadequate portal flow due to thrombosis or hypoplasia of the PV, it is a feasible option to adopt a jump graft as an end-to-side fashion to connect between the small native SMV and the large graft PV.