Ann Liver Transplant.  2021 May;1(1):58-70. 10.52604/alt.21.0006.

Tailored techniques of graft outflow vein reconstruction in pediatric liver transplantation at Asan Medical Center

• Hwang S
• Namgoong JM

• KMID: 2560853
• DOI: http://doi.org/10.52604/alt.21.0006

Abstract

Pediatric recipients are vulnerable to vascular complications because recipient vessels are small. Once graft outflow vein stenosis occurs, it is difficult to treat it effectively. To minimize the risk of hepatic vein outflow obstruction, it is necessary to perform individually designed reconstruction customized to each pediatric liver transplantation (LT) operation. We present our tailored surgical techniques for hepatic vein reconstruction in pediatric LT with the following five topics. 1) recipient hepatic vein unification venoplasty for implantation of left liver and left lateral section grafts; 2) graft hepatic vein venoplasty for left lateral section grafts; 3) graft hepatic vein venoplasty for left lateral section grafts with anomalous left hepatic vein anatomy; 4) graft hepatic vein unification venoplasty for left liver grafts; 5) inferior vena cava replacement during pediatric living donor liver transplantation; and 6) modified piggyback anastomosis of the graft inferior vena cava in infant-to-infant whole liver transplantation. There are three features in our techniques for graft hepatic vein reconstruction, including maximal usage of the recipient hepatic vein stumps, maximal widening of the graft outflow vein orifice through unification and patch venoplasty, and frequent use of vein homografts. In conclusion, secure graft outflow vein reconstruction is the most important step for successful pediatric LT. Thus, every effort should be done to minimize the risk of hepatic vein outflow obstruction. We strongly suggest that the diameter of graft hepatic vein anastomosis should be made as large as possible regardless of recipient age and body size.

Keyword

Hepatic vein stenosis; Hepatic vein outflow obstruction; Vascular insufficiency; Endovascular stenting; Left hepatic vein