Ann Liver Transplant.  2021 Nov;1(2):160-164. 10.52604/alt.21.0020.

Wedged-patch venoplasty for graft left portal vein in pediatric living donor liver transplantation

• Namgoong JM
• Hwang S
• Ha TY
• Kwon H
• Kim KM
• Oh SH

• KMID: 2560867
• DOI: http://doi.org/10.52604/alt.21.0020

Abstract

Portal vein (PV)-size matching is important in preventing anastomotic stenosis in liver transplantation (LT) using a partial liver graft. Reconstruction of small graft PV with size-unmatched recipient PV is challenging, thus we present our surgical technique of wedged-patch venoplasty to enlarge the diameter of graft PV for sizematched reconstruction. On computational simulation, a longitudinal incision was made at the graft PV stump and then a small triangular homograft vein patch was attached. Our simulation showed that a 5-mm incision combined with patch venoplasty could make the diameter of graft PV 30%–50% larger than the native size. We applied this technique to two pediatric patients. The first case was a 4-yearold female patient who underwent second LT because of progressive deterioration of graft function. At the first LDLT operation for biliary atresia, an iliac vein conduit was interposed for PV reconstruction. At the second LT operation, the diameter of interposed PV was 10 mm, but the left liver graft PV was only 7 mm in diameter because of congenital waist. The second case was an 8-year-old female patient who underwent split LT because of intractable recurrent cholangitis following resection of choledochal cyst. The graft PV was small because of type III PV anomaly of the donor liver. We performed wedged venoplasty using an iliac vein homograft patch in these two cases, and no PV complication occurred. In conclusion, our wedgedpatch venoplasty technique can be applied to small graft PV to cope with PV-size mismatching in LT using a partial liver graft.

Keyword

Portal vein stenosis; Venoplasty; Pediatric transplantation; Portal vein anomaly; Vein homograft

Figure

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  Figure 1 Illustration for surgical reconstruction of wedged-patch portal vein venoplasty. A yellow patch indicates a vein allograft. Dotted lines indicate the effective diameter of portal vein reconstruction.

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  Figure 2 Portal vein reconstruction in Case no. 1. (A) Computed tomography of the donor shows a waist at the left portal vein (arrow). (B–D) Wedged-patch venoplasty is performed to the graft portal vein using an iliac vein homograft patch. (E) After portal vein reconstruction, the patch is intervened between the recipient and donor portal veins (arrow). (F) Computed tomography taken at two weeks after transplantation shows a streamlined portal vein without noticeable stenosis.

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  Figure 3 Portal vein reconstruction in Case no. 2. (A–C) Wedged-patch venoplasty is performed to the graft portal vein using an iliac vein homograft patch. (D) End-to-end portal vein reconstruction is performed with adequate size matching. (E) After portal vein reconstruction, the patch is intervened between the recipient and donor portal veins (arrow). (F) Computed tomography taken at one week after transplantation shows a streamlined portal vein without noticeable stenosis. A tissue expander is placed to prevent dextro-rotation of the small liver graft.

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