Ann Liver Transplant.  2023 May;3(1):44-49. 10.52604/alt.23.0002.

Modified left liver graft with funneling venoplasty of middle hepatic vein branches for pediatric living donor liver transplantation

• Namgoong JM
• Park GC
• Hwang S
• Kim SH
• Ha S
• Kim KM
• Oh SH

• KMID: 2560921
• DOI: http://doi.org/10.52604/alt.23.0002

Abstract

We present a case of funneling venoplasty of middle hepatic vein (MHV) branch-preserving left liver (LL) graft in a pediatric patient undergoing living donor liver transplantation (LDLT). The recipient was a 31-month-old girl who was diagnosed with biliary atresia. The patient underwent Kasai portoenterostomy. However, her liver function deteriorated progressively. Thus, we decided to perform LDLT at a body weight of 15 kg. The donor was the 41-year-old mother of the patient. To protect the donor’s remnant liver from excessive hepatic venous congestion (HVC), we recovered an LL graft with preservation of the large segment VIII vein branch. There were three separate outflow veins at the graft liver cut surface, which were unified an iliac vein conduit. Funneling unification bench work resulted in a 3 cm-sized single outflow vein orifice. Standard procedures of pediatric LDLT were performed. Early follow-up computed tomography scans showed no vascular complications with patent graft outflow veins and no HVC at the remnant donor right liver. The patient has been doing well for three months after transplantation. This case suggests that our surgical technique using customized funneling venoplasty could enable successful reconstruction of MHV branches at the LL graft. Our experience suggests that individualized reconstruction techniques should be applied for pediatric patients undergoing LDLT using an LL graft with variant MHV anatomy.

Keyword

Middle hepatic vein; Anatomical variation; Funneling venoplasty; Interposition graft; Left liver graft