Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):313-316. 10.14701/ahbps.22-125.

Portal vein reconstruction in pediatric liver transplantation using end-to-side jump graft: A case report

• Lee J
• Yi NJ
• Kim JY
• Choi HH
• Kim J
• Lee S
• Hong Sy
• Jin US
• Yang SM
• Lee JM
• Hong SK
• Choi Y
• Lee KW
• Suh KS

• KMID: 2545779
• DOI: http://doi.org/10.14701/ahbps.22-125

Abstract

Attenuated portal vein (PV) flow is challenging in pediatric liver transplantation (LT) because it is unsuitable for classic end-to-end jump graft reconstruction from a small superior mesenteric vein (SMV). We thus introduce a novel technique of an end-to-side jump graft from SMV during pediatric LT using an adult partial liver graft. We successfully performed two cases of end-to-side retropancreatic jump graft using an iliac vein graft for PV reconstruction. One patient was a 2-year-old boy with hepatoblastoma and a Yerdel grade 3 PV thrombosis who underwent split LT. Another patient was an 8-month-old girl who had biliary atresia and PV hypoplasia with stenosis on the confluence level of the SMV; she underwent retransplantation because of graft failure related to PV thrombosis. After native PV was resected at the SMV confluence level, an end-to-side reconstruction was done from the proximal SMV to an interposition iliac vein. The interposition vein graft through posterior to the pancreas was obliquely anastomosed to the graft PV. There was no PV related complication during the follow-up period. Using a jump vascular graft in an end-to-side manner to connect the small native SMV and the large graft PV is a feasible treatment option in pediatric recipients with inadequate portal flow due to thrombosis or hypoplasia of the PV.

Keyword

Liver transplantation; Interposition graft; Surgical complication; Hypoplasia; Stenosis

Figure

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  Fig. 1 Reconstruction process of the end-to-side portal vein (PV) and superior mesenteric vein (SMV) reconstruction in retransplantation with PV obliteration. (A) Pre- and post-transplant computed tomography (CT) scans of a hepatoblastoma patient. In the pre-transplant CT scans, it could be seen that PV (black arrowhead) was obliterated, and SMV (white arrow) was drained to gastric varix (white arrowhead). After transplant, recipient main PV and graft left PV (black arrowhead) were well-preserved in 3-month CT scans. (B) Obliterated portal vein and collaterals. Main portal vein stump was obliterated and collaterals to the gastric vein through pancreas were developed.

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  Fig. 2 Reconstruction process of the end-to-side portal vein (PV) and superior mesenteric vein (SMV) reconstruction in retransplantation with PV thrombosis. (A) Computed tomography (CT) scans before second liver transplantation. Left lateral section graft showed infarction because of severe PV (black arrowhead) stenosis at the confluence level. SMV (white arrow) was not dilated without collaterals. Black arrow: splenic vein. (B–E) Reconstruction process of the end-to-side PV and SMV reconstruction using an interposition jump graft. (B) The end of an iliac vein (IV) was approximated to the side of the SMV (white arrow) and temporally clamped. (C) The end-to-side reconstruction was done between the IV and SMV (white arrow). (D) The IV was passed through the retropancreatic path and reclamped for reconstruction to the graft PV. (E) The left PV of the left lateral section graft was anastomosed to a jump interposition IV graft using an oblique method.

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